Provider Demographics
NPI:1902990344
Name:REIGEL, JANET B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:B
Last Name:REIGEL
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 1:1920 NW JOHNSON
Mailing Address - Street 2:SUITE #111
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-335-8038
Mailing Address - Fax:503-274-0843
Practice Address - Street 1:1920 NW JOHNSON
Practice Address - Street 2:SUITE #111
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-335-8038
Practice Address - Fax:503-274-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR222197OtherPRACTITIONER ID NUMBER