| Portland Dbt Institute Of Salem | |
|
5100 S Macadam Ave., Ste 350 Portland OR 97239-3877 | |
| (503) 231-7854 | |
| (503) 231-8153 |
| Full Name | Portland Dbt Institute Of Salem |
|---|---|
| Speciality | Psychologist |
| Location | 5100 S Macadam Ave., Ste 350, Portland, Oregon |
| Authorized Official Name and Position | Loren Wampler (BUSINESS OPERATIONS DIRECTOR) |
| Authorized Official Contact | 5032317854 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portland Dbt Institute Of Salem 5100 S Macadam Ave., Ste. 350 Portland OR 97239-3837 Ph: (503) 231-7854 | Portland Dbt Institute Of Salem 5100 S Macadam Ave., Ste 350 Portland OR 97239-3877 Ph: (503) 231-7854 |
| NPI Number | 1073853966 |
|---|---|
| Provider Enumeration Date | 02/28/2013 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/07/2023 |
| Medicare PECOS PAC ID | 7911141742 |
|---|---|
| Medicare Enrollment ID | O20130918000361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073853966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | (* (Not Available)) | Primary |
| Provider Name | Tiffany A Kerns |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1518051754 PECOS PAC ID: 9638271430 Enrollment ID: I20070226000375 |
| Provider Name | Claudia M Stevens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275748394 PECOS PAC ID: 6507933116 Enrollment ID: I20080924000192 |
| Provider Name | Andrew White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245408350 PECOS PAC ID: 2769645829 Enrollment ID: I20120530000083 |
| Provider Name | Charlotte W Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487845939 PECOS PAC ID: 1759517899 Enrollment ID: I20131120001675 |
| Provider Name | Erica S Tan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447281977 PECOS PAC ID: 7911920749 Enrollment ID: I20140317000540 |
| Provider Name | Bryce Downey Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063795722 PECOS PAC ID: 0345467882 Enrollment ID: I20140807000733 |
| Provider Name | Jennifer Heinlein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649528977 PECOS PAC ID: 1557683976 Enrollment ID: I20141212002002 |
| Provider Name | Landon C Michaels |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033526421 PECOS PAC ID: 5890099337 Enrollment ID: I20160203002990 |
| Provider Name | Jason P Fritts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265713796 PECOS PAC ID: 9638473481 Enrollment ID: I20160215002206 |
| Provider Name | Michele T Sharp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629494018 PECOS PAC ID: 7810111838 Enrollment ID: I20160610000122 |
| Provider Name | Pamela J Buck |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952777898 PECOS PAC ID: 3375829765 Enrollment ID: I20170419003019 |
| Provider Name | Leah R Smart-gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730626144 PECOS PAC ID: 8325315781 Enrollment ID: I20170606002925 |
| Provider Name | Trevor T Cole |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750776407 PECOS PAC ID: 6406116979 Enrollment ID: I20180131001906 |
| Provider Name | Daniel O Swenson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629466552 PECOS PAC ID: 2961766779 Enrollment ID: I20180502002786 |
| Provider Name | Mandy L Porter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730683558 PECOS PAC ID: 1355605007 Enrollment ID: I20180719003857 |
| Provider Name | Jessica L Gotzler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568837235 PECOS PAC ID: 1557615374 Enrollment ID: I20181114002462 |
| Provider Name | Raquel Samantha Friedman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609360759 PECOS PAC ID: 0345672754 Enrollment ID: I20191122000736 |
| Provider Name | Mary Elizabeth Dressler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558705624 PECOS PAC ID: 1153735865 Enrollment ID: I20210120002113 |
| Provider Name | Nicole Suzanne Humphrey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689284739 PECOS PAC ID: 1052726148 Enrollment ID: I20210223002561 |
| Provider Name | Bonnie J Rudder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033544671 PECOS PAC ID: 4587942578 Enrollment ID: I20211021001246 |
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