Healthcare Provider Details

I. General information

NPI: 1548998818
Provider Name (Legal Business Name): ROSS B RENFROE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

IV. Provider business mailing address

18765 SW BOONES FERRY RD STE 100
TUALATIN OR
97062-8607
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax: 503-612-1090
Mailing address:
  • Phone: 503-612-1000
  • Fax: 503-612-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: