Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2484 | OR |
N | 103TC0700X | Clinical Psychologist | 2484 | OR |
N | 103G00000X | Clinical Psychologist | 2484 | OR |
N | 103TC0700X | Clinical Psychologist | 2484 | OR |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2484 | OR |
N | 103TH0004X | Health Psychologist | 2484 | OR |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2484 | OR |
NPI | 1023411485 |
---|---|
Provider Name | Tabitha Becker |
First Address | Lake Oswego, OR 97034-3159 |
Second Address | Lake Oswego, OR 97034-3159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2014 |
Last Update Date | 30/09/2014 |