MEDICARE: SHARON M. LABS, PH.D., L.L.C.

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	103T00000X	Psychologist	608	OR
2	103TC0700X	Clinical Psychologist	608	OR
3	103TH0004X	Health Psychologist	608	OR
4	103TR0400X	Rehabilitation Psychologist	608	OR
5	103G00000X	Clinical Neuropsychologist	608	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1689700163	OTHER	OR	NPI FOR SHARON M. LABS, PH.D., P.C.
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730545468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON M. LABS, PH.D., L.L.C.

Provider Business Mailing Address
First Line	:	2055 SW MOUNT HOOD LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-1561
Country	:	US
Telephone Number	:	503-310-9333
Fax Number	:	503-221-4481

Provider Business Practice Location Address
First Line	:	2055 SW MOUNT HOOD LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-1561
Country	:	US
Telephone Number	:	503-310-9333
Fax Number	:	503-221-4481

Authorized Official
Title or Position	:	NEUROPSYCHOLOGIST/MEMBER MANAGER
Name	:	SHARON M. LABS
Credential	:	PH.D.
Telephone Number	:	503-310-9333

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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