Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2434 | OR |
N | 103G00000X | Clinical Psychologist | 2434 | OR |
N | 103TC0700X | Clinical Psychologist | 2434 | OR |
NPI | 1043593205 |
---|---|
Provider Name | Dr. Heidi Jill Meeke |
First Address | Portland, OR 97205-2234 |
Second Address | Portland, OR 97205-2234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 08/08/2014 |