Provider Demographics
NPI:1225029721
Name:BEICKEL, SHARON L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:BEICKEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:BEICKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHARON L BEICKEL
Mailing Address - Street 1:1678 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2034
Mailing Address - Country:US
Mailing Address - Phone:541-344-6789
Mailing Address - Fax:541-345-6768
Practice Address - Street 1:1678 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2034
Practice Address - Country:US
Practice Address - Phone:541-344-6789
Practice Address - Fax:541-345-6768
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHNPMedicare PIN