Provider Demographics
NPI:1659353746
Name:EASTMAN, ANNE MARGARET (PH D)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARGARET
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-546-0671
Mailing Address - Fax:503-546-0671
Practice Address - Street 1:2929 SW MULTNOMAH BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:503-546-0671
Practice Address - Fax:503-546-0671
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical