Healthcare Provider Details

I. General information

NPI: 1760604631
Provider Name (Legal Business Name): DANI BARRETT NIERENBERG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 NE 134TH ST SUITE 340
VANCOUVER WA
98686-3036
US

IV. Provider business mailing address

2621 NE 134TH ST SUITE 340
VANCOUVER WA
98686-3036
US

V. Phone/Fax

Practice location:
  • Phone: 360-450-0140
  • Fax: 877-343-0535
Mailing address:
  • Phone: 360-450-0140
  • Fax: 877-343-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY15516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1759
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1759
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60263831
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1759
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: