Provider Demographics
NPI:1407968423
Name:MARTINDALE, ELSBETH JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELSBETH
Middle Name:JEAN
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1258
Mailing Address - Country:US
Mailing Address - Phone:503-236-0855
Mailing Address - Fax:503-233-4449
Practice Address - Street 1:5525 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1258
Practice Address - Country:US
Practice Address - Phone:503-236-0855
Practice Address - Fax:503-233-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR936103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHVPMedicare ID - Type Unspecified