Healthcare Provider Details

I. General information

NPI: 1225133655
Provider Name (Legal Business Name): KERN ALVIN OLSON PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 NW NORTHRUP ST 207
PORTLAND OR
97210-2994
US

IV. Provider business mailing address

7805 SW GEARHART DR
BEAVERTON OR
97007-6680
US

V. Phone/Fax

Practice location:
  • Phone: 503-705-8727
  • Fax:
Mailing address:
  • Phone: 503-705-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number382
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: