Healthcare Provider Details

I. General information

NPI: 1891298303
Provider Name (Legal Business Name): CAMPUSPSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 03/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 NE BELKNAP CT STE 101
HILLSBORO OR
97124-8402
US

IV. Provider business mailing address

7710 OAKHILL RD APT F
NORTH ROYALTON OH
44133-6839
US

V. Phone/Fax

Practice location:
  • Phone: 503-744-7766
  • Fax: 503-744-7767
Mailing address:
  • Phone: 440-552-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RENEE DIANE PENNINGTON
Title or Position: OWNER
Credential: CNP
Phone: 503-744-7766