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Individual

JOHN WESLEY REILLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
12636 SE STARK, PORTLAND, OR 97233
(503) 253-4600
(503) 253-4609
Mailing address
PO BOX 82819, PORTLAND, OR 97282
(503) 233-5405
(503) 233-2696

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1173
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
068WDBBQK
NUMBER PERSONAL MEDICARE
OR
05
164936
OR
Enumeration date
10/25/2006
Last updated
07/08/2007
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