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NPI Code Detail

MEDICARE: JOHN THICKINS PSY.D.

MEDICARE: JOHN THICKINS PSY.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
1103TC0700XClinical Psychologist1078OR

General Provider Information

NPI Number : 1528108750
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN THICKINS PSY.D.
Provider Business Mailing Address
First Line : 21900 WILLAMETTE DR STE 202
Second Line :
City : WEST LINN
State : OR
Zip : 97068-3284
Country : US
Telephone Number : 503-653-0631
Fax Number : 503-653-1464
Provider Business Practice Location Address
First Line : 21900 WILLAMETTE DR STE 202
Second Line :
City : WEST LINN
State : OR
Zip : 97068-3284
Country : US
Telephone Number : 503-653-0631
Fax Number : 503-653-0631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 01/26/2018

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