Jacquelyn Dale Lute, BA, AMS

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

12910 SE 137TH Dr
Happy Valley, OR 97086-5873

Phone

(503) 756-8989

NPI assigned

Nov 29, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1245006394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SE LAKE RD STE 175",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222137",
            "telephone_number": "682-250-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12910 SE 137TH DR",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970865873",
            "telephone_number": "503-756-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTE",
        "first_name": "JACQUELYN",
        "middle_name": "DALE",
        "credential": "BA, AMS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tim Ludeman, LPC, MA
• Luna Healthcare LLC
• Joann Lundberg, MA, LPC, ATR-BC
• Tyler Lundquist, D.C.
• Ann-Lien Ai Luong, RN
• Luxottica of America Inc.
• Amanda Ma, DC
• Erin Amayi Magaw, PT, MPT
• Anthony Manzon, PHARMD
• Blake Marcella, PT, DPT

• Behavior Technician in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.