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GEROMEDICAL PSYCHOLOGICAL SERVICES PS NPI 1043501836

NPI Profile

NPI: 1043501836

Provider Name: GEROMEDICAL PSYCHOLOGICAL SERVICES, PS

Classification: Psychologist - 103TC0700X

Entity Type: Organization

Specialization: Clinical

Address:
3550 SW BOND AVE
PORTLAND, OR
ZIP 97239

Phone: (360) 574-9565

GEROMEDICAL PSYCHOLOGICAL SERVICES, PS is a clinical psychologist in Portland, OR. GEROMEDICAL PSYCHOLOGICAL SERVICES, PS NPI is 1043501836. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3550 SW BOND AVE
PORTLAND, OR
ZIP 97239-507
Phone: (360) 574-9565
Fax: (360) 574-9685

The provider's authorized official is Derick A Scovel .
The authorized official title is President and has the following contact phone number (360) 574-9565.

The enumeration date for this NPI number is 4/27/2011 and was last updated on 1/29/2014.

Map - Location of Practice

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103TC0700X Psychologist Clinical 2074 OREGON Yes

What is NPI?
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 6/10/2015