MEDICARE: DR. DEAN ALBERT SHROCK PH.D.

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	103TC0700X	Clinical Psychologist	PSY18597	CA

General Provider Information

NPI Number	:	1194741892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN ALBERT SHROCK PH.D.

Provider Business Mailing Address
First Line	:	374 LEANDRA LN
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6623
Country	:	US
Telephone Number	:	541-826-7740
Fax Number	:	541-826-7740

Provider Business Practice Location Address
First Line	:	374 LEANDRA LN
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-6623
Country	:	US
Telephone Number	:	541-826-7740
Fax Number	:	541-826-7740

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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