Individual
VANESSA ABIGAIL CASILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4920 N INTERSTATE AVE, PORTLAND, OR 97217-3653
(503) 215-3300
(503) 215-3350
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
2090
OR
103TC0700X
Clinical Psychologist
Primary
2090
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500631879
—
OR
Enumeration date
12/14/2010
Last updated
10/14/2020
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