MEDICARE: EMILY DEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E-10250173	OR
2	246Z00000X	Other Specialist/Technologist	E-10250173	OR

General Provider Information

NPI Number	:	1124814819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DEAN

Provider Business Mailing Address
First Line	:	4265 NE HALSEY ST APT 703
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1562
Country	:	US
Telephone Number	:	503-462-8197
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NE 20TH AVE STE 10
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3094
Country	:	US
Telephone Number	:	503-849-2127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	06/01/2026

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Directions to “ EMILY DEAN ” Practice Location

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