MEDICARE: DR. SETH SATURN WILLIAMS PSYD

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	4633	MN
2	103TC0700X	Clinical Psychologist	2227	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311P4WI	OTHER	MN	BCBS NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HP58055	OTHER	MN	HP NUMBER

General Provider Information

NPI Number	:	1851331599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH SATURN WILLIAMS PSYD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12442 SW SCHOLLS FERRY RD
Second Line	:	SUITE 106
City	:	TIGARD
State	:	OR
Zip	:	97223-0803
Country	:	US
Telephone Number	:	503-216-9200
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/01/2013

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