Provider Demographics
NPI:1710779277
Name:SPICKELMIER, JOSEPH PAUL (BA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:SPICKELMIER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 SE ASH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1530
Mailing Address - Country:US
Mailing Address - Phone:951-818-3646
Mailing Address - Fax:
Practice Address - Street 1:815 SE SHERMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4666
Practice Address - Country:US
Practice Address - Phone:971-229-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician