Provider Demographics
NPI:1730283813
Name:ELLIS, ANDREW P (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:7204 SW DURHAM RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7574
Mailing Address - Country:US
Mailing Address - Phone:503-941-9869
Mailing Address - Fax:503-352-5555
Practice Address - Street 1:1815 SW MARLOW
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5185
Practice Address - Country:US
Practice Address - Phone:503-292-0765
Practice Address - Fax:503-292-5208
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-12-15
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Provider Licenses
StateLicense IDTaxonomies
OR1396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist