Provider Demographics
NPI:1700951738
Name:MAGILL, ERIKA BITTNER (PSYD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:BITTNER
Last Name:MAGILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:BITTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9436
Practice Address - Country:US
Practice Address - Phone:503-215-4250
Practice Address - Fax:503-215-4255
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664190Medicaid
ORR172708Medicare PIN
OR500664190Medicaid