MEDICARE: JEFFREY L ANDERSON PSY.D

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	103T00000X	Psychologist	1933	OR

General Provider Information

NPI Number	:	1144385246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L ANDERSON PSY.D

Provider Business Mailing Address
First Line	:	2051 KAEN RD STE 367
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-742-5300
Fax Number	:	503-742-5979

Provider Business Practice Location Address
First Line	:	11211 SE 82ND AVE STE O
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-7624
Country	:	US
Telephone Number	:	503-722-6200
Fax Number	:	503-722-6545

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	01/13/2014

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