Provider Demographics
NPI:1740017391
Name:WATERMAN, CLAIRE ASHLEY (MS)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ASHLEY
Last Name:WATERMAN
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:VAN WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8640 SE CAUSEY AVE APT W206
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-0613
Mailing Address - Country:US
Mailing Address - Phone:254-715-0520
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-558-6286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health