| NPI | 1235131632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA JACOBS Executive Director 503-466-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2015-03-16 |