MEDICARE: DR. ANN HEYEN PH.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	1518	OR

General Provider Information

NPI Number	:	1184713901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN HEYEN PH.D.

Provider Business Mailing Address
First Line	:	2534 SE 31ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7455 SW BEVELAND RD
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8610
Country	:	US
Telephone Number	:	503-624-2600
Fax Number	:	503-624-7752

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ANN HEYEN PH.D.” Practice Location

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