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JENNIFER R ANTICK PHD NPI 1285626507


NPI Information

NPI: 1285626507
Provider Name: JENNIFER R ANTICK, PHD
Classification: Psychologist - 103TC0700X
Entity Type: Individual

Specialization: Clinical

Organization: LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER

PECOS Registration: Yes

Address:
3181 SW SAM JACKSON PARK RD
UHN 80
PORTLAND, OR
ZIP 97239
Phone: (503) 494-7353
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Jennifer R Antick, PHD is a clinical psychologist in Portland, OR with 29 years of experience. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. Jennifer R Antick, PHD NPI is 1285626507. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3181 SW SAM JACKSON PARK RD
UHN 80
PORTLAND, OR
ZIP 97239-011
Phone: (503) 494-7353
Fax: (503) 494-3282

The NPI 1285626507 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 8/22/2005 and was last updated on 12/2/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinicalPY00002039WASHINGTONNo
2103TC0700XPsychologistClinical1853OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1AB26605MEDICARE ID-TYPE UNSPECIFIED
27099252MEDICAIDWASHINGTON
3S44410MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.