MEDICARE: DR. JAMIE LEVIN-EDWARDS 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	OR1077	OR
2	103T00000X	Psychologist	OR1077	OR

General Provider Information

NPI Number	:	1881769610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE LEVIN-EDWARDS PSY.D.

Provider Business Mailing Address
First Line	:	1220 SW MORRISON ST STE 1100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2230
Country	:	US
Telephone Number	:	503-222-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 SW MORRISON ST STE 1100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-2230
Country	:	US
Telephone Number	:	503-222-0557
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	11/19/2009

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