Provider Demographics
NPI:1396733614
Name:JAMISON, POLLYANN HASLAM (PHD)
Entity type:Individual
Prefix:
First Name:POLLYANN
Middle Name:HASLAM
Last Name:JAMISON
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 1:2150 DALTON DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2201
Mailing Address - Country:US
Mailing Address - Phone:541-343-9697
Mailing Address - Fax:541-688-0068
Practice Address - Street 1:2150 DALTON DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2201
Practice Address - Country:US
Practice Address - Phone:541-343-9697
Practice Address - Fax:541-688-0068
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCPFJMedicare ID - Type Unspecified