Healthcare Provider Details

I. General information

NPI: 1588645055
Provider Name (Legal Business Name): JOHN D ADLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NE ROBERTS AVE #330
GRESHAM OR
97030-7404
US

IV. Provider business mailing address

510 NE ROBERTS AVE #330
GRESHAM OR
97030-7404
US

V. Phone/Fax

Practice location:
  • Phone: 503-251-4088
  • Fax:
Mailing address:
  • Phone: 503-251-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0615
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: