Provider Demographics
NPI:1982774386
Name:FANNING-ONO, BRIDGET ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ELAINE
Last Name:FANNING-ONO
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 1:1020 SW TAYLOR ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2543
Mailing Address - Country:US
Mailing Address - Phone:503-544-1868
Mailing Address - Fax:
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2235
Practice Address - Country:US
Practice Address - Phone:503-544-1868
Practice Address - Fax:503-244-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1629OtherPSYCH. LICENSE NUMBER