Provider Demographics
NPI:1356430474
Name:WICHER, DONNA CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:CHRISTINE
Last Name:WICHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 NW 169TH PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7327
Mailing Address - Country:US
Mailing Address - Phone:503-690-9006
Mailing Address - Fax:503-690-4494
Practice Address - Street 1:1865 NW 169TH PL
Practice Address - Street 2:SUITE 201
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7327
Practice Address - Country:US
Practice Address - Phone:503-690-9006
Practice Address - Fax:503-690-4494
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR179374Medicaid
OR179374Medicaid