Provider Demographics
NPI:1609918853
Name:LONGFELLOW, DEAN RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RYAN
Last Name:LONGFELLOW
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16850 SW GLENEAGLE DR
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9639
Mailing Address - Country:US
Mailing Address - Phone:503-703-1222
Mailing Address - Fax:
Practice Address - Street 1:16850 SW GLENEAGLE DR
Practice Address - Street 2:SUITE 16B
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9639
Practice Address - Country:US
Practice Address - Phone:503-703-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical