Individual
JENNIFER R ANTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, UHN 80, PORTLAND, OR 97239-3011
(503) 494-7353
(503) 494-3282
Mailing address
3181 SW SAM JACKSON PARK RD, UHN 80, PORTLAND, OR 97239-3011
(503) 494-7353
(503) 494-3282
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1853
OR
103TC0700X
Clinical Psychologist
PY00002039
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7099252
—
WA
Enumeration date
08/22/2005
Last updated
12/02/2011
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