Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Other names
PROVIDENCE MEDICAL GROUP, PROVIDENCE COGNITIVE ASSESSMENT CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
9155 SW BARNES RD, SUITE 317, PORTLAND, OR 97225-6630
(503) 216-1150
Mailing address
PO BOX 31001 - 4180, PASADENA, CA 91110-4180
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
03/19/2007
Last updated
07/04/2025
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