Provider Demographics
NPI:1659916401
Name:NORTHWEST CHILD ASSESSMENT, LLC
Entity Type:Organization
Organization Name:NORTHWEST CHILD ASSESSMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-314-6505
Mailing Address - Street 1:8228 SW 171ST PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6787
Mailing Address - Country:US
Mailing Address - Phone:503-314-6505
Mailing Address - Fax:
Practice Address - Street 1:8228 SW 171ST PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-6787
Practice Address - Country:US
Practice Address - Phone:503-314-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty