Provider Demographics
NPI:1467730697
Name:WILBUR, REBECCA CHRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CHRISTINE
Last Name:WILBUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NW 22ND AVE STE 516
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3025
Mailing Address - Country:US
Mailing Address - Phone:503-413-6611
Mailing Address - Fax:503-413-8103
Practice Address - Street 1:1015 NW 22ND AVE STE 516
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-6611
Practice Address - Fax:503-413-8103
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2674103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation