Provider Demographics
NPI:1780092296
Name:THIEMAN, ROBERT (MS, NCC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:THIEMAN
Suffix:
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 NE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2809
Mailing Address - Country:US
Mailing Address - Phone:503-239-8101
Mailing Address - Fax:503-239-8106
Practice Address - Street 1:9830 NE CASCADES PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-6832
Practice Address - Country:US
Practice Address - Phone:503-239-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health