Matthew Davis Anderson

Individual provider Active NPI Behavior Technician · Beaverton, OR

NPI 1629619622 · NPPES record last updated Oct 1, 2019

Key facts

NPI
1629619622
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
1800 NW 169TH PL Ste B100
Beaverton, OR 97006-7362
Phone
(503) 350-7050
Fax
(866) 651-5542
NPI assigned
Oct 1, 2019
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Play Connections Autism Services Past
since Oct 6, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X OR Yes

Addresses

Primary practice location

1800 NW 169TH PL Ste B100
Beaverton, OR 97006-7362

Mailing address

1800 NW 169TH PL Ste B100
Beaverton, OR 97006-7362
Phone (503) 350-7050

Other providers in Beaverton, OR

All providers in Beaverton, OR · Behavior Technician in Oregon

Sources for this page

Verify at the official NPI Registry.