Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 22215 | OR |
NPI | 1063769586 |
---|---|
Provider Name | Dr. Nancy Kathryn Ravitch |
First Address | Eugene, OR 97401-2186 |
Second Address | Eugene, OR 97401-2186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2012 |
Last Update Date | 14/12/2014 |