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General NPI Number Information
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NPI Number | 1407886021
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Entity Type | Individual
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Provider Name | HOWARD LAWRENCE DEITCH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 107
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City | PORTLAND
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State | OR
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Zip | 97225-1691
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Country | US
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Telephone | 503-296-5260
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Fax | 503-296-5261
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Provider Business Mailing Address
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Address Line | 4850 SW SCHOLLS FERRY RD STE 107
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City | PORTLAND
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State | OR
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Zip | 97225-1691
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Country | US
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Telephone | 503-296-5260
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Fax | 503-296-5261
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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 | 0553
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License Number State | OR
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