Jan M Deroest, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1842 Issued in OR

Practice address

350 SW 30TH CT
Troutdale, OR 97060-3143

Phone

(503) 475-3274

NPI assigned

Oct 26, 2007

Last updated

Jul 23, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Geromedical Psychological Service PS

  • Clinical Psychologist
  • Portland, OR
  • NPI 1043501836
  NPD (past)
• Geromedical Psychological Service PS

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1659482925
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248307200000",
    "number": "1114106028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 SW 30TH CT",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970603143",
            "telephone_number": "503-475-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SW 30TH CT",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970603143",
            "telephone_number": "503-475-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROEST",
        "first_name": "JAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-26",
        "last_updated": "2009-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1842",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY 00003927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Cope, ND
• Dan E. Cox, LPC
• Danielle D'Aversa
• Matthew James Daskalos, D.O.
• Dana Davies, FNP-C
• Harpreet Kaur Dhillon, D.O.
• Jessie E Dolan, LMT
• Shaylee Mikayla Dukes
• East Wind Care LLC
• Eastside Dental Clinic

• Clinical Psychologist in Troutdale, OR
• Providers in Troutdale, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.