Provider Demographics
NPI:1659748507
Name:TOLLANDER, HEATHER ANNE (PSYD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:TOLLANDER
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:PO BOX 16308
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0308
Mailing Address - Country:US
Mailing Address - Phone:503-255-2343
Mailing Address - Fax:503-255-2344
Practice Address - Street 1:10011 SE DIVISION ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1351
Practice Address - Country:US
Practice Address - Phone:503-255-2343
Practice Address - Fax:503-255-2344
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical