| Kiddos Aba Or Llc | |
|
15405 Sw 116th Ave Ste 111 Portland OR 97224-4103 | |
| (732) 604-7520 | |
| Not Available |
| Full Name | Kiddos Aba Or Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 15405 Sw 116th Ave Ste 111, Portland, Oregon |
| Authorized Official Name and Position | Etty Grossman (COO) |
| Authorized Official Contact | 8482243500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kiddos Aba Or Llc 1005 Broadway Woodmere NY 11598-1227 Ph: (732) 604-7520 | Kiddos Aba Or Llc 15405 Sw 116th Ave Ste 111 Portland OR 97224-4103 Ph: (732) 604-7520 |
| NPI Number | 1285597195 |
|---|---|
| Provider Enumeration Date | 12/08/2025 |
| Last Update Date | 12/08/2025 |
| Certification Date | 12/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285597195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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