MEDICARE: NINFA JOHNSON NEUSER 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	2161	OR
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215261920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINFA JOHNSON NEUSER PSY.D.

Provider Business Mailing Address
First Line	:	12265 SW 127TH AVE
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-1803
Country	:	US
Telephone Number	:	971-238-9292
Fax Number	:	503-360-0600

Provider Business Practice Location Address
First Line	:	1906 SW MADISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1759
Country	:	US
Telephone Number	:	971-238-9292
Fax Number	:	503-360-0600

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

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	11/06/2025

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