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NPI Code Detail

MEDICARE: ERIKA V SAMPLE PSYD

MEDICARE: ERIKA V SAMPLE 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
1103T00000XPsychologist3705OR

General Provider Information

NPI Number : 1992294862
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIKA V SAMPLE PSYD
Provider Business Mailing Address
First Line : 847 NE 19TH AVE STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 35-222-0707
Fax Number :
Provider Business Practice Location Address
First Line : 847 NE 19TH AVE STE 150
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2686
Country : US
Telephone Number : 503-222-0707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2018
Last Update Date : 10/11/2023

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Directions to “ ERIKA V SAMPLE PSYD” Practice Location

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