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Contact Information

JOHN W REILLY, PHD
12636 SE STARK
PORTLAND, OR97233
 Phone: 503-253-4600
 Fax: 503-253-4609
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JOHN W REILLY · (Male)

NPI # 1417032954
Status Active
Credentials PHD
Entity Individual
Enumeration date 10/25/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • OR License # 1173
  • OR Medicaid 164936
  • OR Other 068WDBBQK NUMBER PERSONAL MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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