Provider Demographics
NPI:1235280009
Name:RIORDAN, NOREEN MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:NOREEN
Middle Name:MARGARET
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:MARGARET
Other - Last Name:RIORDAN-SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 MAIN ST
Mailing Address - Street 2:STE 505
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3414
Mailing Address - Country:US
Mailing Address - Phone:360-750-0632
Mailing Address - Fax:503-248-2170
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:STE 505
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3414
Practice Address - Country:US
Practice Address - Phone:360-750-0632
Practice Address - Fax:503-248-2170
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001968103TC0700X
OR1357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR173545Medicare PIN
WAG8926736Medicare PIN
OR325984000001OtherPROVIDENCE PREFERRED
OR1134118Medicare ID - Type Unspecified
WA8858833Medicare ID - Type Unspecified
WA325984000001OtherPROVIDENCE PREFERRED