MEDICARE: SHARON M. LABS PH.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	103G00000X	Clinical Neuropsychologist	608	OR
2	103T00000X	Psychologist	608	OR
3	103TC0700X	Clinical Psychologist	608	OR
4	103TH0100X	Health Service Psychologist	608	OR
5	103TR0400X	Rehabilitation Psychologist	608	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750371191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON M. LABS PH.D.

Provider Business Mailing Address
First Line	:	2055 SW MOUNT HOOD LN
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-1561
Country	:	US
Telephone Number	:	503-224-3393
Fax Number	:	503-310-9333

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	:	503-224-3393
Fax Number	:	503-310-9333

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	12/12/2014

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Practice Location Address:

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Directions to “ SHARON M. LABS PH.D.” Practice Location

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