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General NPI Number Information
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NPI Number | 1427277896
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Entity Type | Individual
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Provider Name | JOAN ELLEN AUSUBEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 317 SW ALDER ST SUITE 1140
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City | PORTLAND
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State | OR
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Zip | 97204-2547
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Country | US
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Telephone | 503-294-2111
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Fax | 503-525-0752
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Provider Business Mailing Address
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Address Line | 8205 SE 11TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-6535
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Country | US
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Telephone | 503-232-6153
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Fax | 503-232-6157
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 735
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License Number State | OR
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