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General NPI Number Information
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NPI Number | 1629925581
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Entity Type | Organization
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Legal Business Name | THE HEALING ROCK LLC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE # 4876
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 971-385-5878
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Fax |
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Provider Business Mailing Address
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Address Line | 7275 SE BERG DR
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City | CORVALLIS
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State | OR
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Zip | 97330-6568
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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 | CLINICAL PSYCHOLOGIST
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Name | DR. PETRA ZDENKOVA
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Credential | PSYD
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Telephone | 971-385-5878
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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 |
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License Number State |
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