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General NPI Number Information
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NPI Number | 1720962426
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Entity Type | Organization
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Legal Business Name | PORTLAND HEALTH AND REHABILITATION PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 5901 S MACADAM AVE STE 100
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City | PORTLAND
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State | OR
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Zip | 97239-3620
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Country | US
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Telephone | 503-567-4952
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 SE ALDER ST STE 301 BOX 112
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 503-567-4952
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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 | REBECCA C WILBUR
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Credential | PSYD
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Telephone | 503-567-4952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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