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General NPI Number Information
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NPI Number | 1821349556
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Entity Type | Individual
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Provider Name | ABBY MARIE EVERAERTS PSYD, M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 20 SE 103RD AVE
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City | PORTLAND
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State | OR
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Zip | 97216-2866
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Country | US
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Telephone | 360-574-9565
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Fax | 360-574-9685
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Provider Business Mailing Address
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Address Line | 10000 NE 7TH AVE SUITE 215
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City | VANCOUVER
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State | WA
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Zip | 98685-4599
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Country | US
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Telephone | 360-574-9565
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Fax | 360-574-9685
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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 | 00000
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License Number State | OR
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