Provider Demographics
NPI:1912039439
Name:REISS, AMY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:S
Last Name:REISS
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 1:7929 SW 37TH AVE
Mailing Address - Street 2:PORTLAND
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7929 SW 37TH AVE
Practice Address - Street 2:PORTLAND
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3663
Practice Address - Country:US
Practice Address - Phone:503-740-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1499103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent