GEROMEDICAL PSYCHOLOGICAL SERVICE PS (NPI# 1043501836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043501836 |
| Entity Type | Organization |
| Organization Name | GEROMEDICAL PSYCHOLOGICAL SERVICE PS |
| Practice Address |
3550 Sw Bond Ave Portland OR 97239-4507 |
| Mailing Address |
2400 Main St Vancouver WA 98660-2663 |
| Practice Telephone | 3605749565 |
| Practice Fax Number | 3605749685 |
| Mailing Telephone | 3605749565 |
| Mailing Fax Number | 3605749685 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2020-09-17 |
| Authorized Official Name | DR. DERICK A SCOVEL (PRESIDENT) |
| Authorized Official Telephone | 3605749565 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
2074 | OR | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659482925 | Geromedical Psychological Service Ps | Psychologist | 2400 Main St, Vancouver, WA 98660-2663 | 2006-08-31 |
| Street Address |
3550 SW BOND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97239-4507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912191909 | Shelly E Boelter | Audiologist | 3550 Sw Bond Ave, Suite 173, Portland, OR 97239-4507 | 2007-09-01 |
| 1609349398 | Calvin Yuan Wah Lee | Physical Therapist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2019-01-06 |
| 1649798745 | Travis Barden | Occupational Therapy Assistant | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2017-09-08 |
| 1174988612 | Kay Linda Foust | Occupational Therapy Assistant | 3550 Sw Bond Ave, Rehab, Portland, OR 97239 | 2015-12-29 |
| 1669840518 | Kenneth Richard Berg | Dentist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2015-09-09 |
| 1427443431 | Curtis Hartling | Audiologist | 3550 Sw Bond Ave, Suite 173, Portland, OR 97239-4507 | 2015-04-06 |
| 1265863989 | Steven Massingale | Physical Therapy Assistant | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2013-12-05 |
| 1487975959 | Mirabella At South Waterfront | Assisted Living Facility | 3550 Sw Bond Ave, Portland, OR 97239-4506 | 2010-06-18 |
| 1497983951 | Erin M Lingo | Physical Therapist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2009-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979468 | Elise Caitlin Esposito | Student in an Organized Health Care Education/Training Program | 3710 Sw U.S. Veterans Hospital Road, Dental Service P-3 Dent, Attn: Elise Esposito, Portland, OR 97239 | 2020-07-16 |
| 1750908844 | Will Cowan | Student in an Organized Health Care Education/Training Program | 455 Sw Us Veterans Hospital Road., Portland, OR 97239 | 2020-07-06 |
| 1881219657 | Desiree Baer | Licensed Vocational Nurse | Sw Us Veterans Hospital Rd, Portland, OR 97239 | 2020-06-08 |
| 1285266205 | Melissa Irene Wheeler | Registered Nurse | Uhs-8l, 3181 S.w. Sam Jackson Park Road, Portland, OR 97239 | 2020-02-07 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1801448063 | Alice Huang Huang | Student in an Organized Health Care Education/Training Program | 3710 Sw Veterans Road, Portland, OR 97239 | 2019-07-09 |
| 1710446273 | Ellen Noreen Kessi | Social Worker | 3710 Sw Us Veterans Rd., Portland, OR 97239 | 2019-03-14 |
| 1508335704 | Jacqueline Marie Mular | Marriage & Family Therapist | 5550 Sw Macadam Suite 100, Portland, OR 97239 | 2018-11-16 |
| 1275030926 | Carly Elizabeth Dougher | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd., Portland, OR 97239 | 2018-04-10 |
| 1780188094 | Dennis John Samuel | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239 | 2018-03-21 |
| Find all providers in zip 97239 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861007387 | Lyle Vintinner | Psychologist | 53 Baxter Blvd Ste 3, Portland, ME 04101-1827 | 2020-09-11 |
| 1194341297 | Natalie Dawn Mitchell | Psychologist | 3762 Sw Council Crest Dr, Portland, OR 97239-1595 | 2020-06-24 |
| 1992331607 | Erin A. Mueller | Psychologist | 718 Sw Alder St Ste 200, Portland, OR 97205-3423 | 2020-03-14 |
| 1952940520 | Timothy Allen Cooper | Psychologist | 3331 Sw Hamilton Ct, Portland, OR 97239-1256 | 2019-12-31 |
| 1215574058 | Northwest Dbt LLC | Psychologist | 2230 Nw Pettygrove St., Suite 130, Portland, OR 97210 | 2019-11-27 |
| 1093373631 | Emily Catherine Stasko | Psychologist | 1950 Nw Raleigh St Apt 201, Portland, OR 97209-1775 | 2019-05-29 |
| 1174094544 | Juniper Psychological Services | Psychologist | 2827 Ne Alberta St, Portland, OR 97211-6350 | 2018-12-11 |
| 1528539335 | Mark G Kiefner Phd LLC | Psychologist | 225 Commercial St Ste 403, Portland, ME 04101-6603 | 2018-12-06 |
| 1467941831 | Shannon Madore | Psychologist | 3710 Sw Us Veterans Hospital Rd # R&d66, Portland, OR 97239-2964 | 2018-05-01 |
| 1033637202 | Kaylin Jones | Psychologist | 1235 Se Division Street, Suite 115, Portland, OR 97202-9720 | 2017-09-07 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.