MEDICARE: RYAN ELIZABETH SPOKES PHD

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	16100	OR

General Provider Information

NPI Number	:	1316083751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ELIZABETH SPOKES PHD

Provider Business Mailing Address
First Line	:	2250 NW FLANDERS ST STE 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-888-6555
Fax Number	:	503-653-5219

Provider Business Practice Location Address
First Line	:	2250 NW FLANDERS ST STE 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-5409
Country	:	US
Telephone Number	:	503-888-6555
Fax Number	:	503-653-5219

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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