Healthcare Provider Details

I. General information

NPI: 1457019978
Provider Name (Legal Business Name): ANDREA MICHELLE ORTEGA-CRIDDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21900 WILLAMETTE DR STE 202
WEST LINN OR
97068-3284
US

IV. Provider business mailing address

1019 E RENTFRO WAY
NEWBERG OR
97132-1696
US

V. Phone/Fax

Practice location:
  • Phone: 503-653-0631
  • Fax:
Mailing address:
  • Phone: 805-598-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: