Healthcare Provider Details

I. General information

NPI: 1013691385
Provider Name (Legal Business Name): NIKITA RAMAKRISHNAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 SW WASHINGTON ST STE 700
PORTLAND OR
97205-3200
US

IV. Provider business mailing address

812 SW WASHINGTON ST STE 700
PORTLAND OR
97205-3200
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax: 503-715-5469
Mailing address:
  • Phone: 503-622-8964
  • Fax: 503-715-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: