Healthcare Provider Details

I. General information

NPI: 1396850129
Provider Name (Legal Business Name): DEBORAH LEE WINER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH L WINER PHD

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 S.W. BEAVERTON-HILLSDALE HIGHWAY SUITE 500
BEAVERTON OR
97005-3037
US

IV. Provider business mailing address

PO BOX 1726
BEAVERTON OR
97075-1726
US

V. Phone/Fax

Practice location:
  • Phone: 503-627-9056
  • Fax: 503-627-0917
Mailing address:
  • Phone: 503-627-9056
  • Fax: 503-627-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number534
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: