Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health & Services - Oregon

Organization Pediatric Neurodevelopmental Disabilities Physician · NPI 1295105518

Providence Health & Services - Oregon is a Pediatric Neurodevelopmental Disabilities Physician in Portland, Oregon. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
3

Practice location Address checks out

830 NE 47th Ave
Portland, OR 97213-2212
Phone: (503) 215-2233
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Child & Adolescent Psychiatry Physician (primary) Taxonomy 2084P0804X
Pediatric Neurodevelopmental Disabilities Physician Taxonomy 2080P0008X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1295105518
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Providence Medical Group; Providence Children'S Development Institute At Child Center
NPI enumeratedSeptember 29, 2015
Last updated in NPPESJune 20, 2025
Certification dateJune 20, 2025
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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