Provider Demographics
NPI:1851430276
Name:PALMER, R SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:SCOTT
Last Name:PALMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 B AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3180
Mailing Address - Country:US
Mailing Address - Phone:530-518-2926
Mailing Address - Fax:530-592-0506
Practice Address - Street 1:3943 TEMPEST DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1928
Practice Address - Country:US
Practice Address - Phone:530-518-2926
Practice Address - Fax:530-592-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3603103T00000X
CA16155103T00000X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X
OR3063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic