Healthcare Provider Details

I. General information

NPI: 1487988846
Provider Name (Legal Business Name): SHERRY ROSE BECKMANN PSYCHOLOGIST, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22831 SW FOREST CREEK DR STE B
SHERWOOD OR
97140-9604
US

IV. Provider business mailing address

1907 E HAWORTH AVE
NEWBERG OR
97132-1269
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-6559
  • Fax: 541-871-7851
Mailing address:
  • Phone: 503-625-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2797
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2797
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: