Provider Demographics
NPI:1962732768
Name:URBAN, MARGARET ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANNE
Last Name:URBAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 SW WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2901
Mailing Address - Country:US
Mailing Address - Phone:541-758-6528
Mailing Address - Fax:
Practice Address - Street 1:5355 SW WILLOW AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2901
Practice Address - Country:US
Practice Address - Phone:541-758-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR808169103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool