Provider Demographics
NPI:1245570605
Name:BLIESNER, ANDREW E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:BLIESNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 WESTLAKE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7700
Mailing Address - Country:US
Mailing Address - Phone:503-984-7353
Mailing Address - Fax:503-372-9094
Practice Address - Street 1:14523 WESTLAKE DR STE A
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7700
Practice Address - Country:US
Practice Address - Phone:503-984-7353
Practice Address - Fax:503-372-9094
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical