Jerusha Beth Detweiler-Bedell, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

1908 Issued in OR

Practice address

5440 SW Westgate Dr.
#175
Portland, OR 97221-2436

Phone

(971) 645-0033

Fax

(503) 297-5744

NPI assigned

Sep 23, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 5, 2023 through Jan 5, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Robert W McLellarn, PHD

  • Cognitive & Behavioral Psychologist
  • Portland, OR
  • NPI 1174813539
  NPD (past)

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254182400000",
    "number": "1346574449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5440 SW WESTGATE DR.",
            "address_2": "#175",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212436",
            "telephone_number": "971-645-0033",
            "fax_number": "503-297-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5440 SW WESTGATE DR.",
            "address_2": "#175",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212436",
            "telephone_number": "971-645-0033",
            "fax_number": "503-297-5744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWEILER-BEDELL",
        "first_name": "JERUSHA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-23",
        "last_updated": "2009-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "OR",
            "license": "1908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Detlefsen, MD
• Katherine I Detrick, RDH
• Richard William Detroye, L.AC.
• Lyle Dettloff
• Jessie Dettwiler
• Kara Y Detwiller, M.D.
• Alexander Deussen, LCSW
• Joann S. Deutsche, FNP
• Anuradha Devabhaktuni
• Maria Gilson Devalpine, PMHNP

• Cognitive & Behavioral Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Cognitive & Behavioral Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.