Provider Demographics
NPI:1306132220
Name:PATRICIA CAMPLAIR, PHD PC
Entity type:Organization
Organization Name:PATRICIA CAMPLAIR, PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:503-827-5135
Mailing Address - Street 1:1020 SW TAYLOR ST STE 720
Mailing Address - Street 2:PO BOX 91117
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2512
Mailing Address - Country:US
Mailing Address - Phone:503-827-5135
Mailing Address - Fax:503-848-6101
Practice Address - Street 1:1020 SW TAYLOR ST STE 720
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2512
Practice Address - Country:US
Practice Address - Phone:503-827-5135
Practice Address - Fax:503-848-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR946261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR11824Medicare PIN