Provider Demographics
NPI:1629395918
Name:MARTIN-GERHARDS, REBECCA (EDD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:MARTIN-GERHARDS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SW TAYLOR ST STE 740
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2505
Mailing Address - Country:US
Mailing Address - Phone:503-243-2900
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 740
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2505
Practice Address - Country:US
Practice Address - Phone:503-243-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist