| Providence Cognitive Assessment Clinic | |
|
9155 Sw Barnes Rd Suite 317 Portland OR 97225-6630 | |
| (503) 216-1150 | |
| Not Available |
| Full Name | Providence Cognitive Assessment Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 9155 Sw Barnes Rd, Portland, Oregon |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Cognitive Assessment Clinic Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Cognitive Assessment Clinic 9155 Sw Barnes Rd Suite 317 Portland OR 97225-6630 Ph: (503) 216-1150 |
| NPI Number | 1679697247 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 11/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679697247 | NPI | - | NPPES |
| 274078 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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