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311 B Ave Suite R Lake Oswego OR 97034-3011 | |
| (503) 692-4092 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 311 B Ave, Lake Oswego, Oregon |
| Authorized Official Name and Position | Rita Maynard (PSYCHOLOGIST) |
| Authorized Official Contact | 5036924092 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
311 B Ave Suite R Lake Oswego OR 97034-3011 Ph: (503) 692-4092 | 311 B Ave Suite R Lake Oswego OR 97034-3011 Ph: (503) 692-4092 |
| NPI Number | 1275602187 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 12/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275602187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 847 (Oregon) | Primary |
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