Individual
DR. JACQUELINE LEE GEDDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
11630 SE 40TH AVE, SUITE A, MILWAUKIE, OR 97222-6195
(503) 739-5365
(971) 231-1420
Mailing address
11630 SE 40TH AVE, SUITE A, MILWAUKIE, OR 97222-6195
(503) 739-5365
(971) 231-1420
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2366
OR
103T00000X
Psychologist
PY00003673
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50068100
DMAP
OR
Enumeration date
01/11/2006
Last updated
10/06/2016
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