Healthcare Provider Details

I. General information

NPI: 1952593758
Provider Name (Legal Business Name): POLARIS PSYCHIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 NW SPRUCE AVE STE 102
CORVALLIS OR
97330-2297
US

IV. Provider business mailing address

975 NW SPRUCE AVE STE 102
CORVALLIS OR
97330-2297
US

V. Phone/Fax

Practice location:
  • Phone: 541-738-8727
  • Fax: 754-758-4503
Mailing address:
  • Phone: 541-738-8727
  • Fax: 754-758-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD19576
License Number StateOR

VIII. Authorized Official

Name: DR. REBECCA M SWIFF
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 541-753-6445