| Willamette Falls Neuropsychology Llc | |
|
619 Madison St Ste 108 Oregon City OR 97045-2354 | |
| (503) 303-4257 | |
| (503) 387-3957 |
| Full Name | Willamette Falls Neuropsychology Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 619 Madison St Ste 108, Oregon City, Oregon |
| Authorized Official Name and Position | Loren Mallory (OWNER) |
| Authorized Official Contact | 5033034257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willamette Falls Neuropsychology Llc 619 Madison St Ste 108 Oregon City OR 97045-2354 Ph: (503) 303-4257 | Willamette Falls Neuropsychology Llc 619 Madison St Ste 108 Oregon City OR 97045-2354 Ph: (503) 303-4257 |
| NPI Number | 1316533979 |
|---|---|
| Provider Enumeration Date | 12/17/2020 |
| Last Update Date | 12/17/2020 |
| Certification Date | 12/17/2020 |
| Medicare PECOS PAC ID | 3375952419 |
|---|---|
| Medicare Enrollment ID | O20210503000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316533979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Loren E Mallory |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992853402 PECOS PAC ID: 4486814829 Enrollment ID: I20180508000604 |
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