Provider Demographics
NPI:1447678644
Name:WAMSER, NANCIE POTTER (JD, MA MFT)
Entity type:Individual
Prefix:
First Name:NANCIE
Middle Name:POTTER
Last Name:WAMSER
Suffix:
Gender:F
Credentials:JD, MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 NE SANDY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4948
Mailing Address - Country:US
Mailing Address - Phone:503-253-0964
Mailing Address - Fax:503-253-7659
Practice Address - Street 1:8383 NE SANDY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4948
Practice Address - Country:US
Practice Address - Phone:503-253-0964
Practice Address - Fax:503-253-7659
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist