Provider Demographics
NPI:1952616393
Name:MINER, ANN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:
Last Name:MINER
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 1:975 SE SANDY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2498
Mailing Address - Country:US
Mailing Address - Phone:503-351-9432
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST STE 1010
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2340
Practice Address - Country:US
Practice Address - Phone:503-610-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801177902OtherNPI