Healthcare Provider Details

I. General information

NPI: 1730097262
Provider Name (Legal Business Name): PHOEBE YOUNG EDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N DIXON ST
PORTLAND OR
97227-1804
US

IV. Provider business mailing address

501 N DIXON ST
PORTLAND OR
97227-1804
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number582507
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: