MEDICARE: PATRICIA CAMPLAIR, PHD PC

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	261QM0850X	Adult Mental Health Clinic/Center	946	OR

General Provider Information

NPI Number	:	1306132220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICIA CAMPLAIR, PHD PC

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST STE 720
Second Line	:	PO BOX 91117
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	503-827-5135
Fax Number	:	503-848-6101

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST STE 720
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2512
Country	:	US
Telephone Number	:	503-827-5135
Fax Number	:	503-848-6101

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PATRICIA CAMPLAIR
Credential	:	PH D
Telephone Number	:	503-827-5135

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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