Provider Demographics
NPI:1891098893
Name:SCHWARTZ, AUDREY LIZ (PHD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LIZ
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LIZ
Other - Last Name:OLDHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2992 NE NEWCASTLE PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4118
Mailing Address - Country:US
Mailing Address - Phone:541-910-1361
Mailing Address - Fax:
Practice Address - Street 1:1300 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6277
Practice Address - Country:US
Practice Address - Phone:541-257-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist