Provider Demographics
NPI:1790883759
Name:PULLAN, JUDITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:PULLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4550 KRUSE WAY
Mailing Address - Street 2:STE 340
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3586
Mailing Address - Country:US
Mailing Address - Phone:503-977-0400
Mailing Address - Fax:503-635-0583
Practice Address - Street 1:1 CENTERPOINTE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8623
Practice Address - Country:US
Practice Address - Phone:503-977-0400
Practice Address - Fax:503-619-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OROR1275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101563Medicare ID - Type Unspecified