Provider Demographics
NPI:1285773648
Name:LARSON REAM, JANE SUSAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:SUSAN
Last Name:LARSON REAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:SUSAN
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3210 SE 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:503-349-6100
Mailing Address - Fax:503-274-1902
Practice Address - Street 1:3210 SE 156TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:503-349-6100
Practice Address - Fax:503-274-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical