Active NPI
Susan Lynn Dragovich, PHD
- Forensic Psychologist
- Bend, OR
National Provider Identifier
1477618346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- 389
- Practice address
- 1012 NW Wall 260
Bend, OR 97701 - Phone
- (541) 388-0180
- Fax
- (541) 388-0180
- NPI assigned
- Dec 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 389 | OR | |
| Forensic Psychologist | 103TF0200X | 389 | OR | Primary |
Addresses
Primary practice location
1012 NW Wall 260
Bend, OR 97701
Mailing address
1012 NW Wall Street Suite 260
Bend, OR 97701
Phone (541) 388-0180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078535 J25302 | Other | OR | OR OMAP PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 389 | OR | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1477618346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 NW WALL STREET SUITE 260",
"city": "BEND",
"state": "OR",
"postal_code": "97701",
"telephone_number": "541-388-0180",
"fax_number": "541-388-0180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 NW WALL 260",
"city": "BEND",
"state": "OR",
"postal_code": "97701",
"telephone_number": "541-388-0180",
"fax_number": "541-388-0180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAGOVICH",
"first_name": "SUSAN",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "389",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "OR",
"license": "389",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OR OMAP PROVIDER",
"identifier": "078535 J25302",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.