Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | TBD | OR |
Y | 103TC0700X | Clinical Psychologist | TBD | OR |
N | 103TH0004X | Health Psychologist | TBD | OR |
N | 103TH0100X | Health Service | TBD | OR |
NPI | 1093373631 |
---|---|
Provider Name | Dr. Emily Catherine Stasko |
First Address | Portland, OR 97209-1775 |
Second Address | Portland, OR 97209-1775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2019 |
Last Update Date | 29/05/2019 |