Provider Demographics
NPI:1932605508
Name:OREGON INSTITUTE OF TECHNOLOGY
Entity Type:Organization
Organization Name:OREGON INSTITUTE OF TECHNOLOGY
Other - Org Name:BEHAVIOR IMPROVEMENT GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOC PROF/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D, LBA
Authorized Official - Phone:541-885-1673
Mailing Address - Street 1:3201 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-8801
Mailing Address - Country:US
Mailing Address - Phone:541-885-1673
Mailing Address - Fax:
Practice Address - Street 1:2631 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603
Practice Address - Country:US
Practice Address - Phone:850-933-4742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2497103K00000X, 106E00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty