MEDICARE: ERIKA BETH RUBER ERIKA RUBER

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	101Y00000X	Counselor	L3767	OR

General Provider Information

NPI Number	:	1508195751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA BETH RUBER ERIKA RUBER

Provider Business Mailing Address
First Line	:	1020 NE TILLAMOOK ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-4060
Country	:	US
Telephone Number	:	503-680-7292
Fax Number	:	971-254-4882

Provider Business Practice Location Address
First Line	:	3500 NE MLK JR BLVD STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2093
Country	:	US
Telephone Number	:	503-680-7292
Fax Number	:	971-254-4882

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

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	02/08/2017

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