MEDICARE: DR. JILL ELIZABETH SPENDAL PSY.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	1574	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	022952	OTHER	OR	OMAP PROVIDER NUMBER

General Provider Information

NPI Number	:	1538100656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL ELIZABETH SPENDAL PSY.D.

Provider Business Mailing Address
First Line	:	1020 SW TAYLOR ST
Second Line	:	SUITE 260
City	:	PORTLAND
State	:	OR
Zip	:	97205-2543
Country	:	US
Telephone Number	:	503-242-3521
Fax Number	:	503-222-3741

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST
Second Line	:	SUITE 260
City	:	PORTLAND
State	:	OR
Zip	:	97205-2543
Country	:	US
Telephone Number	:	503-242-3521
Fax Number	:	503-222-3741

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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