Provider Demographics
NPI:1164401329
Name:O'REILLY, CONNIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:A
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18156 NW CAMBRAY ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3432
Mailing Address - Country:US
Mailing Address - Phone:503-533-8109
Mailing Address - Fax:
Practice Address - Street 1:18156 NW CAMBRAY ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3432
Practice Address - Country:US
Practice Address - Phone:503-644-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13573Medicare UPIN
OR0000TCHSXMedicare ID - Type UnspecifiedMEDICARE