Provider Demographics
NPI:1346855566
Name:RAMANUJAM, KRISHNAPRIYA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISHNAPRIYA
Middle Name:
Last Name:RAMANUJAM
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 1:8817 SW 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3373
Mailing Address - Country:US
Mailing Address - Phone:937-260-0618
Mailing Address - Fax:
Practice Address - Street 1:6443 SW BEAVERTON HILLSDALE HWY STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-4210
Practice Address - Country:US
Practice Address - Phone:503-452-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3234103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist