Provider Demographics
NPI:1487717609
Name:FISHMAN, LINDA M (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:FISHMAN
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 1:2153 SW MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1124
Mailing Address - Country:US
Mailing Address - Phone:503-705-9462
Mailing Address - Fax:
Practice Address - Street 1:2153 SW MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1124
Practice Address - Country:US
Practice Address - Phone:503-705-9462
Practice Address - Fax:503-227-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840665000OtherREGENCE BCBSO
OR840665000OtherREGENCE BCBSO