MEDICARE: KATHARINE D SLUYS 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	103TC0700X	Clinical Psychologist	3009	OR

General Provider Information

NPI Number	:	1346725249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE D SLUYS PSYD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	541-535-1274
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N PHOENIX RD STE A
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-9100
Country	:	US
Telephone Number	:	541-535-1274
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	01/17/2019

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