NPI 1265831705 · live from the CMS NPI Registry
Serita Backstrand, Psy.D
Psychologist in Beaverton, OR. National Provider Identifier 1265831705, active.
NPI record
| NPI | 1265831705 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 1791 Nw 173rd Ave Ste 140, Beaverton, OR 97006 |
| Practice phone | 503-533-9806 |
| Enumerated | August 21, 2014 |
| Last updated | April 1, 2019 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist | 103T00000X | PY60776565 (WA) |
| Psychologist primary | 103T00000X | 2933 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.