Basic Information
| Provider Information | |||||||||
| NPI: | 1225409428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUTHER | ||||||||
| FirstName: | CORRIGAN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18765 SW BOONES FERRY RD | ||||||||
| Address2: | |||||||||
| City: | TUALATIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970628496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036242600 | ||||||||
| FaxNumber: | 5036247752 | ||||||||
| Practice Location | |||||||||
| Address1: | 7455 SW BEVELAND RD | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036242600 | ||||||||
| FaxNumber: | 5036247752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 08/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0114006 | OR | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.