Individual
PAUL EDWARD GUASTADISEGNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
511 SW 10TH AVE, SUITE 1115, PORTLAND, OR 97205-2732
(503) 223-7766
(503) 223-8844
Mailing address
511 SW 10TH AVE, SUITE 1115, PORTLAND, OR 97205-2732
(503) 223-7766
(503) 223-8844
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1307
OR
103TC0700X
Clinical Psychologist
1307
OR
103TC2200X
Clinical Child & Adolescent Psychologist
1307
OR
103TF0200X
Forensic Psychologist
1307
OR
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
1307
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159027
—
OR
01
—
M39331
OREGON VENDOR NUMBER
OR
Enumeration date
03/28/2007
Last updated
09/11/2025
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