Provider Demographics
NPI:1134112725
Name:NEWTON, WENDY GOLDBERG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:GOLDBERG
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 NE HANCOCK ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5321
Mailing Address - Country:US
Mailing Address - Phone:503-869-9092
Mailing Address - Fax:503-473-8273
Practice Address - Street 1:3939 NE HANCOCK ST
Practice Address - Street 2:SUITE 314
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-869-9092
Practice Address - Fax:503-473-8273
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182537Medicaid
ORR112900Medicare ID - Type Unspecified
OR182537Medicaid