Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0718 | OR |
N | 103TC0700X | Clinical Psychologist | 0718 | OR |
Y | 103TC1900X | Counseling Psychologist | 0718 | OR |
NPI | 1104962513 |
---|---|
Provider Name | Dr. Suzanne Ruth Gascoyne |
First Address | Eugene, OR 97405-0985 |
Second Address | Eugene, OR 97401-4159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 12/11/2019 |