Healthcare Provider Details

I. General information

NPI: 1255416152
Provider Name (Legal Business Name): PATRICIA MARY BJORKQUIST PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 GLEN CREEK RD NW STE 250
SALEM OR
97304-3198
US

IV. Provider business mailing address

525 GLEN CREEK RD NW STE 250
SALEM OR
97304-3198
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-1333
  • Fax: 503-589-1347
Mailing address:
  • Phone: 503-585-1333
  • Fax: 503-589-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number661
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: