Provider Demographics
NPI:1699971770
Name:VERSTEEG, EDWARD BRUCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
Last Name:VERSTEEG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 SW SANDBURG ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8073
Mailing Address - Country:US
Mailing Address - Phone:503-684-6205
Mailing Address - Fax:503-624-1322
Practice Address - Street 1:6975 SW SANDBURG ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8073
Practice Address - Country:US
Practice Address - Phone:503-684-6205
Practice Address - Fax:503-624-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHZVMedicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST