Provider Demographics
NPI:1346302684
Name:BRYANT, NANCY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:R
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 WILLAMETTE FALLS DR STE 200B
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4658
Mailing Address - Country:US
Mailing Address - Phone:503-655-3505
Mailing Address - Fax:
Practice Address - Street 1:2008 WILLAMETTE FALLS DR STE 200A
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4673
Practice Address - Country:US
Practice Address - Phone:503-655-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150942Medicaid
OR150942Medicaid