Provider Demographics
NPI:1164550224
Name:FENN, DARIEN STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARIEN
Middle Name:STEPHEN
Last Name:FENN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23540 SW GAGE RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9721
Mailing Address - Country:US
Mailing Address - Phone:503-320-2503
Mailing Address - Fax:503-928-5582
Practice Address - Street 1:23540 SW GAGE RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9721
Practice Address - Country:US
Practice Address - Phone:503-320-2503
Practice Address - Fax:503-928-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical