Provider Demographics
NPI:1538227806
Name:PEARSON, EDWIN ERIC (PHD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ERIC
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 E MAIN ST STE A101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7137
Mailing Address - Country:US
Mailing Address - Phone:541-482-5376
Mailing Address - Fax:541-552-1899
Practice Address - Street 1:843 E MAIN ST STE A101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7137
Practice Address - Country:US
Practice Address - Phone:541-482-5376
Practice Address - Fax:541-552-1899
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR316103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHKMMedicare ID - Type UnspecifiedPSYCHOLOGIST