Healthcare Provider Details

I. General information

NPI: 1689604290
Provider Name (Legal Business Name): STEPHEN R CONDON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SE COURT AVE STE 4
PENDLETON OR
97801-2251
US

IV. Provider business mailing address

125 SE COURT AVE STE 4
PENDLETON OR
97801-2251
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-4123
  • Fax: 541-278-4123
Mailing address:
  • Phone: 541-278-4123
  • Fax: 541-278-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number570
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: