Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1678 | OR |
NPI | 1043422413 |
---|---|
Provider Name | Laura Sheffield Bennett |
First Address | Portland, OR 97220-5670 |
Second Address | Portland, OR 97220-5670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2007 |
Last Update Date | 30/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026862 | OMAP NUMBER (01) | OR |