Provider Demographics
NPI:1588390769
Name:WEISSMAN, MEREDITH MARIE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MARIE
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SE RURAL ST APT 155
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5863
Mailing Address - Country:US
Mailing Address - Phone:678-634-2240
Mailing Address - Fax:
Practice Address - Street 1:5440 SW WESTGATE DR STE 350
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2447
Practice Address - Country:US
Practice Address - Phone:678-634-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty