Provider Demographics
NPI:1831318260
Name:LONDAGIN, GLORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:LONDAGIN
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 1:3041 NE ALAMEDA TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1631
Mailing Address - Country:US
Mailing Address - Phone:503-224-8116
Mailing Address - Fax:
Practice Address - Street 1:3041 NE ALAMEDA TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1631
Practice Address - Country:US
Practice Address - Phone:503-224-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3176103T00000X, 103TC0700X
OR1231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY31673OtherPSYCHOLOGY LICENSE
OR3176OtherPSYCHOLOGY LICENSE