Provider Demographics
NPI:1346574449
Name:DETWEILER-BEDELL, JERUSHA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERUSHA
Middle Name:BETH
Last Name:DETWEILER-BEDELL
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 1:5440 SW WESTGATE DR.
Mailing Address - Street 2:#175
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2436
Mailing Address - Country:US
Mailing Address - Phone:971-645-0033
Mailing Address - Fax:503-297-5744
Practice Address - Street 1:5440 SW WESTGATE DR.
Practice Address - Street 2:#175
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2436
Practice Address - Country:US
Practice Address - Phone:971-645-0033
Practice Address - Fax:503-297-5744
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1908103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral