Active NPI
Winston Anderson, PSY.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1619112018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1751
- Practice address
- 1500 NE Irving St
Suite 250
Portland, OR 97232-2243 - Phone
- (503) 258-4200
- NPI assigned
- Dec 13, 2008
- Last updated
- Dec 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1751 | OR | Primary |
Addresses
Primary practice location
1500 NE Irving St
Suite 250
Portland, OR 97232-2243
Mailing address
4207 NE 32ND Ave
Portland, OR 97211-7149
Phone (503) 206-6643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1751 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229126400000",
"number": "1619112018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4207 NE 32ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972117149",
"telephone_number": "503-206-6643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 NE IRVING ST",
"address_2": "SUITE 250",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322243",
"telephone_number": "503-258-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "WINSTON",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-13",
"last_updated": "2008-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.