Healthcare Provider Details

I. General information

NPI: 1407926843
Provider Name (Legal Business Name): PATRICIA A WARFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BRUTSCHER ST SUITE 214
NEWBERG OR
97132-6094
US

IV. Provider business mailing address

901 BRUTSCHER ST STE D
NEWBERG OR
97132-6096
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-8172
  • Fax:
Mailing address:
  • Phone: 503-554-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1303
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: