Provider Demographics
NPI:1124814819
Name:DEAN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DEAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:RAINEY
Other - Middle Name:J
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1209 NE LINDEN AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3905
Mailing Address - Country:US
Mailing Address - Phone:208-801-8943
Mailing Address - Fax:
Practice Address - Street 1:2340 SE GLADSTONE ST # 12
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2962
Practice Address - Country:US
Practice Address - Phone:503-849-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORE-10250173246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other