Provider Demographics
NPI:1043271083
Name:MCCLARD, KRISTEN LYN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYN
Last Name:MCCLARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:LYN
Other - Last Name:TWIST MCCLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-231-7854
Mailing Address - Fax:
Practice Address - Street 1:2929 SW MULTNOMAH BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4025
Practice Address - Country:US
Practice Address - Phone:503-231-7854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1689103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136775Medicare PIN