Provider Demographics
NPI:1215901186
Name:LANDES, HERBERT RODNEY (PHD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:RODNEY
Last Name:LANDES
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 1:833 SW 11TH AVE
Mailing Address - Street 2:SUITE 424
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2125
Mailing Address - Country:US
Mailing Address - Phone:503-248-2189
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:SUITE 424
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2125
Practice Address - Country:US
Practice Address - Phone:503-248-2189
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist