MEDICARE: DR. ROBERT GERALD STANULIS 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	103G00000X	Clinical Neuropsychologist	398	OR
2	103T00000X	Psychologist	398	OR

General Provider Information

NPI Number	:	1811144090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GERALD STANULIS PH.D.

Provider Business Mailing Address
First Line	:	10940 SW BARNES RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5368
Country	:	US
Telephone Number	:	503-816-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	10940 SW BARNES RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5368
Country	:	US
Telephone Number	:	503-816-5093
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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Directions to “ DR. ROBERT GERALD STANULIS PH.D.” Practice Location

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