MEDICARE: DR. JANE HEIY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	2644	OR

General Provider Information

NPI Number	:	1033527973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE HEIY PH.D.

Provider Business Mailing Address
First Line	:	6916 N GREELEY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5236
Country	:	US
Telephone Number	:	618-514-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6916 N GREELEY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5236
Country	:	US
Telephone Number	:	618-514-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	11/11/2020

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