Healthcare Provider Details

I. General information

NPI: 1982996179
Provider Name (Legal Business Name): RICHARD KOLBELL, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 NE BROADWAY ST
PORTLAND OR
97232-1501
US

IV. Provider business mailing address

1923 NE BROADWAY ST
PORTLAND OR
97232-1501
US

V. Phone/Fax

Practice location:
  • Phone: 503-284-2371
  • Fax:
Mailing address:
  • Phone: 503-284-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1084
License Number StateOR

VIII. Authorized Official

Name: DR. RICHARD KOLBELL
Title or Position: OWNER
Credential: PHD
Phone: 503-284-2372