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General NPI Number Information
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NPI Number | 1679793541
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Entity Type | Organization
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Legal Business Name | CLEARWATER ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 516 SE MORRISON ST STE 620
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City | PORTLAND
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State | OR
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Zip | 97214-6305
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Country | US
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Telephone | 503-274-7855
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Fax |
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Provider Business Mailing Address
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Address Line | 516 SE MORRISON ST #1010
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City | PORTLAND
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State | OR
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Zip | 97214-2340
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Country | US
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Telephone | 503-232-0992
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Fax | 503-232-0791
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Authorized Official
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Title or Position | MEMBER/PARTNER FOR CLEARWATER ASSOC
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Name | DR. MICHELLE L BOBOWICK
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Credential | PSY.D.
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Telephone | 503-232-0992
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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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