| NPI | 1164820478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY KREILING Executive Director 541-306-6456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 2524) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 2524) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2018-10-17 |