Healthcare Provider Details

I. General information

NPI: 1356430474
Provider Name (Legal Business Name): DONNA CHRISTINE WICHER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 NW 169TH PL SUITE 201
BEAVERTON OR
97006-7327
US

IV. Provider business mailing address

1865 NW 169TH PL SUITE 201
BEAVERTON OR
97006-7327
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-9006
  • Fax: 503-690-4494
Mailing address:
  • Phone: 503-690-9006
  • Fax: 503-690-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number642
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: