Provider Demographics
NPI:1588706147
Name:SCHNEIDER, JOHN RICHARD (PHD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:SCHNEIDER
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 1:3570 SW RIVER PARKWAY
Mailing Address - Street 2:SUITE # 601
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-280-9833
Mailing Address - Fax:
Practice Address - Street 1:5331 SW MACADAM AVE
Practice Address - Street 2:SUITE # 397
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3871
Practice Address - Country:US
Practice Address - Phone:503-281-8828
Practice Address - Fax:503-228-4732
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0354103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist