Provider Demographics
NPI:1790878106
Name:BEATTIE, SUSAN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5531
Mailing Address - Country:US
Mailing Address - Phone:619-232-2841
Mailing Address - Fax:503-296-2637
Practice Address - Street 1:5606 NE 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5531
Practice Address - Country:US
Practice Address - Phone:619-232-2841
Practice Address - Fax:503-296-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR730103TC0700X
WA1151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical