Provider Demographics
NPI:1508848383
Name:MENDELSON, ALEC NORMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEC
Middle Name:NORMAN
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NW EASTMAN PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3858
Mailing Address - Country:US
Mailing Address - Phone:503-665-4357
Mailing Address - Fax:503-665-3260
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-665-4357
Practice Address - Fax:503-665-3260
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR787103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00000TCHWGMedicare ID - Type UnspecifiedMEDICARE PROVIDER #