Provider Demographics
NPI:1699802595
Name:STUCKEY, F. ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:F. ROBERT
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2535
Mailing Address - Country:US
Mailing Address - Phone:503-223-6550
Mailing Address - Fax:503-223-6561
Practice Address - Street 1:1925 NW 23RD PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2535
Practice Address - Country:US
Practice Address - Phone:503-223-6550
Practice Address - Fax:503-223-6561
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical