Provider Demographics
NPI:1326196940
Name:GIL-KASHIWABARA, ELEANOR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:GIL-KASHIWABARA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:GIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 NE MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2344
Mailing Address - Country:US
Mailing Address - Phone:503-735-1070
Mailing Address - Fax:
Practice Address - Street 1:3121 S MOODY AVE STE 185
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4505
Practice Address - Country:US
Practice Address - Phone:503-453-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1595103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026485Medicaid