Healthcare Provider Details

I. General information

NPI: 1255606513
Provider Name (Legal Business Name): PAMELA RUTH RICE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 SW MACADAM AVE SUITE 200
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

12200 SE MCLOUGHLIN BLVD APT.#11-202
MILWAUKIE OR
97222-7281
US

V. Phone/Fax

Practice location:
  • Phone: 503-841-6222
  • Fax: 503-841-6199
Mailing address:
  • Phone: 503-758-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10215
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: