Active NPI
Jacklyn Rae
- Behavior Analyst
- Beaverton, OR
National Provider Identifier
1225485378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 10176093
- Practice address
- 6200 SW Arctic Dr
Beaverton, OR 97005-9447 - Phone
- (503) 224-2184
- NPI assigned
- May 18, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 10176093 | OR | Primary |
Addresses
Primary practice location
6200 SW Arctic Dr
Beaverton, OR 97005-9447
Mailing address
21600 Oxnard St
Suite 1800
Woodland Hills, CA 91367-4976
Phone (818) 345-2345
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 |
|---|---|---|---|
| 10176093 | OR | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463529600000",
"number": "1225485378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 OXNARD ST",
"address_2": "SUITE 1800",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913674976",
"telephone_number": "818-345-2345",
"fax_number": "818-449-0994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 SW ARCTIC DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970059447",
"telephone_number": "503-224-2184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAE",
"first_name": "JACKLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-18",
"last_updated": "2016-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "10176093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.