Provider Demographics
NPI:1679760169
Name:SOLA, ANN B (PSYD, MPH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:SOLA
Suffix:
Gender:F
Credentials:PSYD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SE SPOKANE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6487
Mailing Address - Country:US
Mailing Address - Phone:503-329-8198
Mailing Address - Fax:
Practice Address - Street 1:205 SE SPOKANE ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6487
Practice Address - Country:US
Practice Address - Phone:503-329-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical