Healthcare Provider Details

I. General information

NPI: 1376697185
Provider Name (Legal Business Name): AMY MEE-RAN DORIN KOBUS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-6176
  • Fax: 503-494-6152
Mailing address:
  • Phone: 503-494-6176
  • Fax: 503-494-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1481
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: