Active NPI
Scott Clark
- Behavior Analyst
- Portland, OR
National Provider Identifier
1336752286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-24-71112
- Practice address
- 5457 SW Canyon CT
Portland, OR 97221-2401 - Phone
- (971) 762-4663
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- 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 Analyst | 103K00000X | 1-24-71112 | OR | Primary |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
5457 SW Canyon CT
Portland, OR 97221-2401
Mailing address
5457 SW Canyon CT
Portland, OR 97221-2401
Phone (971) 762-4663
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1336752286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5457 SW CANYON CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212401",
"telephone_number": "971-762-4663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5457 SW CANYON CT",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212401",
"telephone_number": "971-762-4663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2024-02-27",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "1-24-71112",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"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 Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.