Provider Demographics
NPI:1760917140
Name:SCHULTZ, BRADLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SW SKYLINE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2545
Mailing Address - Country:US
Mailing Address - Phone:503-894-9630
Mailing Address - Fax:833-642-0439
Practice Address - Street 1:1750 SW SKYLINE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2545
Practice Address - Country:US
Practice Address - Phone:503-894-9630
Practice Address - Fax:833-642-0439
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3591103T00000X
WAPY61357253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist