Healthcare Provider Details

I. General information

NPI: 1659353746
Provider Name (Legal Business Name): ANNE MARGARET EASTMAN PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEG EASTMAN PH. D.

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 SW MULTNOMAH BLVD SUITE 304
PORTLAND OR
97219
US

IV. Provider business mailing address

2929 SW MULTNOMAH BLVD SUITE 304
PORTLAND OR
97219
US

V. Phone/Fax

Practice location:
  • Phone: 503-546-0671
  • Fax: 503-546-0671
Mailing address:
  • Phone: 503-546-0671
  • Fax: 503-546-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number462
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: