MEDICARE: REBECCA ROBB-HICKS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1583	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	804692004	OTHER	OR	BLUE CROSS BLUE SHIELD
2	A004	OTHER	OR	TRICARE

General Provider Information

NPI Number	:	1164512943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ROBB-HICKS PSYD

Provider Business Mailing Address
First Line	:	2230 NW PETTYGROVE ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-227-0350
Fax Number	:	503-227-0745

Provider Business Practice Location Address
First Line	:	2230 NW PETTYGROVE ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-227-0350
Fax Number	:	503-227-0745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	04/12/2024

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Directions to “ REBECCA ROBB-HICKS PSYD” Practice Location

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