Provider Demographics
NPI:1942326038
Name:YOMAN, JEROME (PHD, ABBP)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:YOMAN
Suffix:
Gender:M
Credentials:PHD, ABBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2049
Mailing Address - Country:US
Mailing Address - Phone:503-643-9805
Mailing Address - Fax:503-643-9815
Practice Address - Street 1:3815 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2049
Practice Address - Country:US
Practice Address - Phone:503-643-9805
Practice Address - Fax:503-643-9815
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13841103TC0700X
OR1894103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13841Medicare ID - Type Unspecified