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General NPI Number Information
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NPI Number | 1508027111
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Entity Type | Individual
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Provider Name | TRUDE ZMOELNIG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 668 MCVEY AVE 123
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-4853
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Country | US
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Telephone | 503-636-4819
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Fax |
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Provider Business Mailing Address
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Address Line | 668 MCVEY AVE 123
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-4853
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Country | US
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Telephone | 503-636-4819
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 15468 INACTIVE
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License Number State | CA
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