Jeanne Lynne Carlson, PH.D.

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

1252 Issued in OR

Practice address

10531 SW Capitol Hwy
Portland, OR 97219-6812

Phone

(503) 916-5681

Fax

(503) 916-2655

NPI assigned

May 22, 2007

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720298656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25563",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972980563",
            "telephone_number": "503-916-5681",
            "fax_number": "503-916-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10531 SW CAPITOL HWY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972196812",
            "telephone_number": "503-916-5681",
            "fax_number": "503-916-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JEANNE",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "OR",
            "license": "1252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dustin Daniel Carlson, FNP
• Dustin M Carlson, M.D.
• Esther Carlson
• Hans Lowell Carlson, MD
• Isaac Carlson, BCBA
• Joshua James Carlson
• Kayla Carlson, MPH
• Mark Frederick Carlson, M.S., CCC-SLP
• Martin D Carlson, LMT, MMP
• Mathew Carlson

• Prescribing (Medical) Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Prescribing (Medical) Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.