Provider Demographics
NPI:1942365671
Name:HANCOCK, JOHN E (EDD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0615 SW PALATINE HILL RD
Mailing Address - Street 2:LEWIS AND CLARK COLLEGE MSC 135
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7879
Mailing Address - Country:US
Mailing Address - Phone:503-768-7160
Mailing Address - Fax:503-768-7115
Practice Address - Street 1:0615 SW PALATINE HILL RD
Practice Address - Street 2:LEWIS AND CLARK COLLEGE MSC 135
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7879
Practice Address - Country:US
Practice Address - Phone:503-768-7160
Practice Address - Fax:503-768-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1145103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR108113Medicare PIN