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General NPI Number Information
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NPI Number | 1033386339
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Entity Type | Individual
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Provider Name | RICHARD WALTER WOLLERT PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 1220 SW MORRISON ST STE 930
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City | PORTLAND
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State | OR
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Zip | 97205-2228
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Country | US
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Telephone | 360-737-7712
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Fax | 503-241-7971
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Provider Business Mailing Address
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Address Line | 1220 SW MORRISON ST STE 930
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City | PORTLAND
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State | OR
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Zip | 97205-2228
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Country | US
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Telephone | 360-737-7712
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Fax | 503-241-7971
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 795
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License Number State | OR
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