Active NPI
Rachel M. Jackson, BEHAVIOR ANALYST
- Behavior Analyst
- Portland, OR
National Provider Identifier
1023591047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- ABA-B-10209046
- Practice address
- 4949 SW Macadam Ave # 30
Portland, OR 97239-3912 - Phone
- (888) 273-4292
- Fax
- (888) 293-3374
- NPI assigned
- Sep 14, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-18-53582 | CO | |
| Behavior Analyst | 103K00000X | ABA-B-10209046 | OR | Primary |
Addresses
Primary practice location
4949 SW Macadam Ave # 30
Portland, OR 97239-3912
Mailing address
11037 Warner Ave # 339
Fountain Valley, CA 92708-4007
Phone (714) 848-8319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ABA-B-10209046 | OR | MD | Behavioral Analyst |
| RBT-18-53582 | CO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Footprints Behavior Interventions | Past | Accepting new patients | |
| Footprints Behavioral Interventions, Inc. | Behavior Technician | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Fountain Valley, CA
- NPI 1770004830
-
dba Footprints Behavioral Interventions
- Early Intervention Provider Agency
- Santa Ana, CA
- NPI 1780978858
Behavior Technician
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608595200000",
"number": "1023591047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11037 WARNER AVE # 339",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084007",
"telephone_number": "714-848-8319",
"fax_number": "714-596-6274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4949 SW MACADAM AVE # 30",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393912",
"telephone_number": "888-273-4292",
"fax_number": "888-293-3374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RACHEL",
"middle_name": "M.",
"credential": "BEHAVIOR ANALYST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-14",
"last_updated": "2020-12-22",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "RBT-18-53582",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "ABA-B-10209046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.