Healthcare Provider Details

I. General information

NPI: 1508848383
Provider Name (Legal Business Name): ALEC NORMAN MENDELSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NW EASTMAN PKWY SUITE 280
GRESHAM OR
97030-3858
US

IV. Provider business mailing address

1550 NW EASTMAN PKWY SUITE 280
GRESHAM OR
97030-3858
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-4357
  • Fax: 503-665-3260
Mailing address:
  • Phone: 503-665-4357
  • Fax: 503-665-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number787
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: