Psych NW, PC
Organization Active NPI Psychologist · Lake Oswego, OR
NPI 1487047007 · NPPES record last updated Mar 5, 2015
Key facts
- NPI
- 1487047007
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychologist 103T00000X
- License
- 1929 (OR)
- Legal business name
- PSYCH NW, PC
- Practice address
- 17704 Jean Way Ste 105
Lake Oswego, OR 97035-5586 - Phone
- (503) 877-0711
- Fax
- (503) 914-0315
- NPI assigned
- Mar 5, 2015
- Organization subpart
- No
Authorized official
- Name
- Scott T Alvord, PSY, D
- Title
- President
- Phone
- (503) 476-5005
Practitioners 6
-
Andrew Knowles, PSYD
-
Maya M Williams, PHD
-
Scott Thomas Alvord, PSYD
-
Stephen Hans Stoltzfus, PSYD
-
Michelle Franke, PSYD
-
Erin Vogel, MA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190718002761 | OR | Part B Supplier - Clinic/Group Practice | 3375878952 |
Receives reassigned benefits from 4 practitioners Practice locations: Salem, OR |
National Provider Directory
Locations
1907 Garden Ave
Ste 201
Eugene, OR 97403
Phone (503) 877-0711
4068 Hudson Ave NE
Salem, OR 97301
Phone (503) 877-0711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | 1929 | OR | Yes |
Addresses
Primary practice location
17704 Jean Way Ste 105
Lake Oswego, OR 97035-5586
Mailing address
PO Box 10024
Eugene, OR 97440-2024
Phone (503) 877-0711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500614581MCD | Medicaid | OR |
Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.