Healthcare Provider Details

I. General information

NPI: 1518904457
Provider Name (Legal Business Name): REDMOND ANDREW REAMS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NE 40TH AVE
PORTLAND OR
97212-5405
US

IV. Provider business mailing address

2106 NE 40TH AVE
PORTLAND OR
97212-5405
US

V. Phone/Fax

Practice location:
  • Phone: 503-299-4492
  • Fax: 503-274-2327
Mailing address:
  • Phone: 503-299-4492
  • Fax: 503-274-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number887
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: