Healthcare Provider Details

I. General information

NPI: 1750411997
Provider Name (Legal Business Name): REBECCA SUSANNE HART PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 8TH AVE UNIT 2
EUGENE OR
97401-2709
US

IV. Provider business mailing address

PO BOX 40156
EUGENE OR
97404-0023
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-9412
  • Fax:
Mailing address:
  • Phone: 541-357-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19864
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2201
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2201
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: