Individual
KIMBERLY RIDEOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 SW MACADAM AVE STE 580, PORTLAND, OR 97239-3837
(503) 231-7854
Mailing address
5200 SW MACADAM AVE STE 580, PORTLAND, OR 97239-3837
(503) 231-7854
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2367
OR
Other
Enumeration date
10/09/2007
Last updated
11/07/2018
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