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NPI Code Detail

MEDICARE: DR. DERENDA MARIE SCHUBERT PH.D.

MEDICARE:  DR. DERENDA MARIE SCHUBERT  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
1103TC0700XClinical Psychologist1247OR

General Provider Information

NPI Number : 1790836245
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DERENDA MARIE SCHUBERT PH.D.
Provider Business Mailing Address
First Line : 365 NE WILLIAMS RD
Second Line :
City : GRESHAM
State : OR
Zip : 97030-1867
Country : US
Telephone Number : 503-618-0416
Fax Number :
Provider Business Practice Location Address
First Line : 3415 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3371
Country : US
Telephone Number : 503-234-9591
Fax Number : 503-205-0189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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Directions to “ DR. DERENDA MARIE SCHUBERT PH.D.” Practice Location

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