Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 608 | OR |
Y | 103TC0700X | Clinical Psychologist | 608 | OR |
N | 102L00000X | Psychologist | 608 | OR |
N | 103T00000X | Psychologist | 608 | OR |
N | 103G00000X | Clinical Psychologist | 608 | OR |
N | 103TC0700X | Clinical Psychologist | 608 | OR |
N | 103TH0100X | Health Service | 608 | OR |
N | 103TR0400X | Rehabilitation Psychologist | 608 | OR |
NPI | 1750371191 |
---|---|
Provider Name | Sharon M. Labs |
First Address | Portland, OR 97239-1561 |
Second Address | Portland, OR 97239-1561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 12/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150266 | (05) | OR |