MEDICARE: BARBARA BRECK 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	103TC0700X	Clinical Psychologist	655	OR

General Provider Information

NPI Number	:	1891763595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA BRECK PH.D

Provider Business Mailing Address
First Line	:	2051 KAEN RD
Second Line	:	SUITE 367
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-742-5300
Fax Number	:	503-742-5304

Provider Business Practice Location Address
First Line	:	2051 KAEN RD FL 1
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-655-8401
Fax Number	:	503-655-8429

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/17/2010

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Directions to “ BARBARA BRECK PH.D” Practice Location

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