Individual
BRANDY LEE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6536 SE DUKE ST, PORTLAND, OR 97206-6665
(503) 406-6546
(503) 386-3354
Mailing address
6536 SE DUKE ST, PORTLAND, OR 97206-6665
(503) 406-6546
(503) 386-3354
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3798
OR
Other
Enumeration date
01/03/2014
Last updated
10/06/2025
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