Healthcare Provider Details

I. General information

NPI: 1750669313
Provider Name (Legal Business Name): JANE TRAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SW MARLOW AVE STE 200
PORTLAND OR
97225-5102
US

IV. Provider business mailing address

498 SW 140TH AVE
BEAVERTON OR
97006-6051
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-6479
  • Fax: 503-228-4248
Mailing address:
  • Phone: 503-526-2919
  • Fax: 503-228-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1789
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: