Provider Demographics
NPI:1932355674
Name:WALDMAN, JILL S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:S
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST
Mailing Address - Street 2:SUITE 619 & 630
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2234
Mailing Address - Country:US
Mailing Address - Phone:971-256-2314
Mailing Address - Fax:503-841-5389
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:619 & 630
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:971-256-2314
Practice Address - Fax:503-841-5389
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2703103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent