MEDICARE: MARY KAY AUGUST PH.D.

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	02183	MD
2	103T00000X	Psychologist	1810	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48341	OTHER	MD	MAMSI

General Provider Information

NPI Number	:	1326042169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KAY AUGUST PH.D.

Provider Business Mailing Address
First Line	:	10200 NW ALDER GROVE LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-7584
Country	:	US
Telephone Number	:	240-409-5798
Fax Number	:

Provider Business Practice Location Address
First Line	:	10200 NW ALDER GROVE LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-7584
Country	:	US
Telephone Number	:	240-409-5798
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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