Angela Kathryn Pickering, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

10201681 Issued in OR

Practice address

18765 SW Boones Ferry Rd
Tualatin, OR 97062-8496

Phone

(503) 233-5405

NPI assigned

Sep 5, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Angela Kathryn Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lifestancehealth.angelapickering@148835.advancedmd-direct.com

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

{
    "created_epoch": "1473033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1972050268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 SE 36TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145184",
            "telephone_number": "530-209-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18765 SW BOONES FERRY RD",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628496",
            "telephone_number": "503-233-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERING",
        "first_name": "ANGELA",
        "middle_name": "KATHRYN",
        "name_prefix": "Mrs.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-05",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "OR",
            "license": "10201681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164936",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "JOHNSON",
            "middle_name": "KATHRYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa C Pew, MD
• Ian Pham, DMD
• Ashley Phillips, PT, DPT
• Thomas A Phipps, MD
• Elizabeth Pickels, PHARMD
• Cassandre Piersol, ANP-BC
• Joanne C Plapp, RN
• Play to Grow Developmental Therapy Services
• Play2Grow Behavioral Therapy
• Anita Felicita Ploghoft, MS OTR CHT

• Behavior Analyst in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Behavior Analyst in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.