| Wildwood Psychiatric Resource Center | |
|
16110 Sw Regatta Ln Beaverton OR 97006-8942 | |
| (503) 629-2131 | |
| (503) 617-9379 |
| Full Name | Wildwood Psychiatric Resource Center |
|---|---|
| Speciality | Psychologist |
| Location | 16110 Sw Regatta Ln, Beaverton, Oregon |
| Authorized Official Name and Position | Ann J. Howard (PRESIDENT) |
| Authorized Official Contact | 5036908606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildwood Psychiatric Resource Center Po Box 610 Fairview OR 97024-0610 Ph: (503) 963-1221 | Wildwood Psychiatric Resource Center 16110 Sw Regatta Ln Beaverton OR 97006-8942 Ph: (503) 629-2131 |
| NPI Number | 1235181868 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 07/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235181868 | NPI | - | NPPES |
| 054123000 | Other | OR | BLUE CROSS NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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