Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 2249 | OR |
Y | 103G00000X | Clinical Psychologist | 2249 | OR |
Y | 103TC0700X | Clinical Psychologist | 2249 | OR |
NPI | 1235556077 |
---|---|
Provider Name | Sara Phillips |
First Address | Salem, OR 97301-2669 |
Second Address | Salem, OR 97301-2669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2014 |
Last Update Date | 17/11/2015 |