Provider Demographics
NPI:1245572015
Name:ZANDER, BETHANY MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:ZANDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7965 SW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5685
Mailing Address - Country:US
Mailing Address - Phone:219-793-2360
Mailing Address - Fax:
Practice Address - Street 1:22344 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9416
Practice Address - Country:US
Practice Address - Phone:219-793-2360
Practice Address - Fax:503-625-3768
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2821103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist