Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1395 | OR |
NPI | 1114095700 |
---|---|
Provider Name | Mr. Peter Greg Sprengelmeyer |
First Address | Eugene, OR 97401-8311 |
Second Address | Eugene, OR 97401-8311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |