Healthcare Provider Details

I. General information

NPI: 1992682314
Provider Name (Legal Business Name): ACKERMAN PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51579 COLUMBIA RIVER HWY STE I
SCAPPOOSE OR
97056-8411
US

IV. Provider business mailing address

2000 NE 42ND AVE STE D2021
PORTLAND OR
97213-1399
US

V. Phone/Fax

Practice location:
  • Phone: 971-352-1601
  • Fax: 503-543-6040
Mailing address:
  • Phone: 971-352-1601
  • Fax: 503-543-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHLOE LEANORA ACKERMAN
Title or Position: PRESIDENT
Credential: PSYD
Phone: 971-352-1601