Provider Demographics
NPI:1477736577
Name:CHERRY, REBECCA JOANN (PSYD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOANN
Last Name:CHERRY
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 1:236 NW GARIBALDI ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3053
Mailing Address - Country:US
Mailing Address - Phone:971-228-8447
Mailing Address - Fax:
Practice Address - Street 1:21210 NW MAUZEY RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9327
Practice Address - Country:US
Practice Address - Phone:503-439-9531
Practice Address - Fax:503-531-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor