=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043667850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFFANIE LA TORRE PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2016
-----------------------------------------------------
Last Update Date | 03/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 SW SKYLINE BLVD STE 201
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97221-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-444-7500
-----------------------------------------------------
Fax | 503-841-5389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6149
-----------------------------------------------------
City | ALOHA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-352-8657
-----------------------------------------------------
Fax | 503-352-8658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 3471
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------