Provider Demographics
NPI:1336294214
Name:NATASHA WONG, P.C.
Entity Type:Organization
Organization Name:NATASHA WONG, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:AE
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-560-9828
Mailing Address - Street 1:1271 NE HIGHWAY 99W
Mailing Address - Street 2:#169
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1271 NE HIGHWAY 99W # 169
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2720
Practice Address - Country:US
Practice Address - Phone:503-560-9828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty