Provider Demographics
NPI:1568720928
Name:ACKERMAN, CHLOE LEANORA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:LEANORA
Last Name:ACKERMAN
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 1:51579 COLUMBIA RIVER HWY STE I
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-8411
Mailing Address - Country:US
Mailing Address - Phone:971-352-1601
Mailing Address - Fax:503-543-6040
Practice Address - Street 1:51579 COLUMBIA RIVER HWY STE I
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-8411
Practice Address - Country:US
Practice Address - Phone:971-352-1601
Practice Address - Fax:503-543-6040
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical