Individual
DR. JEANNE RENEE TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-7151
(503) 413-8130
Mailing address
PO BOX 4037, PORTLAND, OR 97208-4037
(503) 413-4048
(503) 413-2910
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2820
OR
Other
Enumeration date
07/19/2013
Last updated
06/23/2022
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