Individual
JACK RANDELL WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
9135 SW BARNES RD STE 561, PORTLAND, OR 97225-6643
(503) 216-2339
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3238
OR
103TC0700X
Clinical Psychologist
PSY.0005193
CO
Other
Enumeration date
03/22/2011
Last updated
05/13/2025
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