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General NPI Number Information
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NPI Number | 1588574032
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Entity Type | Organization
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Legal Business Name | AUTISM AND PSYCHOLOGICAL EVALUATION CLINIC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1611 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8284
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Country | US
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Telephone | 541-690-2906
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Fax | 541-236-1555
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Provider Business Mailing Address
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Address Line | 1611 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8284
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JEFFREY FRY
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Credential | PHD
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Telephone | 941-932-6341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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