Provider Demographics
NPI:1730536913
Name:ALLIGOOD, KRYSTLE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:ALLIGOOD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:MS
Other - First Name:KRYSTLE
Other - Middle Name:LEANN
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 SE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4581
Mailing Address - Country:US
Mailing Address - Phone:503-421-8299
Mailing Address - Fax:
Practice Address - Street 1:3500 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-509-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003802103K00000X
ORABA-B-10176354103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst