MEDICARE: DR. RENEE KATHERINE PIRKL 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	1570	OR

General Provider Information

NPI Number	:	1639244759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE KATHERINE PIRKL PSY.D.

Provider Business Mailing Address
First Line	:	3601 SW RIVER PKWY
Second Line	:	SUITE 2012
City	:	PORTLAND
State	:	OR
Zip	:	97239-4553
Country	:	US
Telephone Number	:	503-223-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 SW RIVER PKWY
Second Line	:	SUITE 2012
City	:	PORTLAND
State	:	OR
Zip	:	97239-4553
Country	:	US
Telephone Number	:	503-223-2929
Fax Number	:

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	02/20/2012

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