Provider Demographics
NPI:1760020796
Name:WOESSNER, EMELYNE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMELYNE
Middle Name:M
Last Name:WOESSNER
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 1:1334 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4523
Mailing Address - Country:US
Mailing Address - Phone:541-243-3894
Mailing Address - Fax:
Practice Address - Street 1:260 SW MADISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4725
Practice Address - Country:US
Practice Address - Phone:541-378-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist