Provider Demographics
NPI:1255843371
Name:BALL, ADELAIDE (MA, BCBA, LBA-OR/TX)
Entity type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:MA, BCBA, LBA-OR/TX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 SE SPOKANE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6708
Mailing Address - Country:US
Mailing Address - Phone:971-373-4028
Mailing Address - Fax:
Practice Address - Street 1:912 NE KELLY AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5629
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NCRBT-17-43008106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician