| Sundstrom Clinical Services Llc | |
|
21900 Willamette Dr Ste 202 West Linn OR 97068-3284 | |
| (503) 653-0631 | |
| (503) 653-1464 |
| Full Name | Sundstrom Clinical Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 21900 Willamette Dr Ste 202, West Linn, Oregon |
| Authorized Official Name and Position | Carol Lazrine (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 5036530631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sundstrom Clinical Services Llc 21900 Willamette Dr Ste 202 West Linn OR 97068-3284 Ph: (503) 653-0631 | Sundstrom Clinical Services Llc 21900 Willamette Dr Ste 202 West Linn OR 97068-3284 Ph: (503) 653-0631 |
| NPI Number | 1669508412 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 01/30/2018 |
| Medicare PECOS PAC ID | 7113980467 |
|---|---|
| Medicare Enrollment ID | O20041108000526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669508412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 01229457-2 (Oregon) | Primary |
| Provider Name | Tamara L Hoogestraat |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871787754 PECOS PAC ID: 4587708110 Enrollment ID: I20100220000425 |
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