Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2770 | OR |
Y | 103TC0700X | Clinical Psychologist | 2770 | OR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2770 | OR |
NPI | 1093196487 |
---|---|
Provider Name | Dr. Allison Brandt |
First Address | Portland, OR 97205-2217 |
Second Address | Portland, OR 97205-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 18/01/2021 |