MEDICARE: CYNTHIA M POLANCE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1997	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245474949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA M POLANCE PSYD

Provider Business Mailing Address
First Line	:	7912 SW 35TH AVE STE 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-2427
Country	:	US
Telephone Number	:	503-278-4970
Fax Number	:	503-447-6640

Provider Business Practice Location Address
First Line	:	7912 SW 35TH AVE STE 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-2427
Country	:	US
Telephone Number	:	503-278-4970
Fax Number	:	503-447-6640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	03/27/2020

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