Provider Demographics
NPI:1407002850
Name:ANDERSON, MIRIAM JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:JOY
Last Name:ANDERSON
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 1:516 SE MORRISON ST STE 1110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2390
Mailing Address - Country:US
Mailing Address - Phone:503-222-0707
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST STE 1110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2390
Practice Address - Country:US
Practice Address - Phone:503-222-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical