NPI 1801096334 · live from the CMS NPI Registry
Scott A Bandoroff, Psychologist (PhD)
Psychologist, Clinical Child & Adolescent in Ashland, OR. National Provider Identifier 1801096334, active.
NPI record
| NPI | 1801096334 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical Child & Adolescent 103TC2200X |
| Practice location | 149 Clear Creek Dr, Suite 110, Ashland, OR 97520 |
| Practice phone | 541-951-4329 |
| Mailing address | P.O. Box 503010, X, White City, OR 97503 |
| Enumerated | July 23, 2007 |
| Last updated | April 17, 2012 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical Child & Adolescent | 103TC2200X | 1120 (OR) |
| Psychologist, Clinical Child & Adolescent primary | 103TC2200X | OR1120 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.