MEDICARE: DR. BARBARA M PANTHER-GIBBY 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	1178	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	:	1942349089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA M PANTHER-GIBBY PSYD

Provider Business Mailing Address
First Line	:	1911 MOUNTAIN VIEW LANE
Second Line	:	STE. 500
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2248
Country	:	US
Telephone Number	:	503-357-0206
Fax Number	:	503-357-9003

Provider Business Practice Location Address
First Line	:	1911 MOUNTAIN VIEW LANE
Second Line	:	STE. 500
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2248
Country	:	US
Telephone Number	:	503-357-0206
Fax Number	:	503-357-9003

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/15/2015

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