Connie Eldridge-Pederson, PHD, PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1070 Issued in OR

Legal business name

CONNIE ELDRIDGE-PEDERSON, PHD, PC

Practice address

1611 NE 16TH Ave
Portland, OR 97232-1413

Phone

(503) 287-4426

Fax

(503) 284-6051

NPI assigned

Mar 4, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Connie Eldridge-Pederson, PHD

Title

President

Phone

(503) 287-4426

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sue Ellen Collins-Larson, M.A., LPC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1801009865
  NPD (past)
• Constance Eldridge Pederson, PH.D.

  • Psychologist
  • Portland, OR
  • NPI 1548460637
  NPD (past)

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

{
    "created_epoch": "1236124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237248000000",
    "number": "1740420603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 NE 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321413",
            "telephone_number": "503-287-4426",
            "fax_number": "503-284-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 NE 16TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321413",
            "telephone_number": "503-287-4426",
            "fax_number": "503-284-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNIE ELDRIDGE-PEDERSON, PHD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-04",
        "last_updated": "2009-03-17",
        "status": "A",
        "authorized_official_last_name": "ELDRIDGE-PEDERSON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-287-4426",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "1070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Conner
• Valerie Margaret Conner, MS RD CDE
• William Edward Conner
• Lucinda Connery, PMHNP
• Quinn H Connick, MA, BA
• Michelle Conniff
• Trina Hazel Connolly-Fairchild
• Allison M. Connolly, AUD
• Amy Michelle Connolly, LPC
• Coleen A Connolly, MD

• Community/Behavioral Health Agency in Portland, OR
• Providers in Portland, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.