Provider Demographics
NPI:1316962624
Name:SHERMAN, LINDA G (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 NW MURRAY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5552
Mailing Address - Country:US
Mailing Address - Phone:503-643-6525
Mailing Address - Fax:503-643-6058
Practice Address - Street 1:1225 NW MURRAY RD STE 108
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5552
Practice Address - Country:US
Practice Address - Phone:503-643-6525
Practice Address - Fax:503-643-6058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 0512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS06727Medicare UPIN
ORR0000TCGWTMedicare ID - Type UnspecifiedMEDICARE