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General NPI Number Information
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NPI Number | 1558425926
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Entity Type | Individual
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Provider Name | PHYLLIS M RICHARDSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 1112 NE 21ST AVE SUITE 5
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City | PORTLAND
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State | OR
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Zip | 97232-2595
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Country | US
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Telephone | 503-281-1897
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Fax | 503-281-4862
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Provider Business Mailing Address
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Address Line | 1112 NE 21ST AVE SUITE 5
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City | PORTLAND
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State | OR
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Zip | 97232
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Country | US
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Telephone | 503-281-1897
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Fax | 503-281-4862
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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 | 668
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License Number State | OR
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