Provider Demographics
NPI:1144222381
Name:HOWIESON, DIANE B (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:B
Last Name:HOWIESON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11322 SW RIVERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8447
Mailing Address - Country:US
Mailing Address - Phone:503-636-0836
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:STE 720
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2512
Practice Address - Country:US
Practice Address - Phone:503-827-5135
Practice Address - Fax:503-636-8190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR397103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR111267Medicare PIN