Provider Demographics
NPI:1336367218
Name:CLINE, JANET Y (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:Y
Last Name:CLINE
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:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:
Practice Address - Street 1:1500 NW BETHANY BLVD STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5238
Practice Address - Country:US
Practice Address - Phone:503-567-3260
Practice Address - Fax:503-567-3264
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2251101YP2500X
OR2092103TC0700X
WALH 60062930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
WA0000WDBCHOtherGROUP MEDICARE
OR000WDBCHOtherGROUP MEDICARE