Individual
DR. TIMOTHY A ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1626 NE BRYANT ST, PORTLAND, OR 97211-4712
(503) 936-5067
Mailing address
1626 NE BRYANT ST, PORTLAND, OR 97211-4712
(503) 936-5067
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2684
OR
103T00000X
Psychologist
867
NE
103T00000X
Psychologist
PSO17610
PA
103TC0700X
Clinical Psychologist
867
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
Enumeration date
03/23/2007
Last updated
12/05/2023
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