Provider Demographics
NPI:1164820478
Name:NEUROPSYCHOLOGICAL SERVICES OF OREGON, LLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL SERVICES OF OREGON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREILING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-306-6456
Mailing Address - Street 1:231 SW SCALEHOUSE LOOP STE 203
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1277
Mailing Address - Country:US
Mailing Address - Phone:541-306-6456
Mailing Address - Fax:541-647-1580
Practice Address - Street 1:231 SW SCALEHOUSE LOOP STE 203
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1277
Practice Address - Country:US
Practice Address - Phone:541-306-6456
Practice Address - Fax:541-647-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2524103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty