Provider Demographics
NPI:1184770513
Name:SCHRADLE, SUSAN BETH (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BETH
Last Name:SCHRADLE
Suffix:
Gender:F
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:PO BOX 30886
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294-3886
Mailing Address - Country:US
Mailing Address - Phone:503-254-0959
Mailing Address - Fax:
Practice Address - Street 1:1525 NE WEIDLER
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1410
Practice Address - Country:US
Practice Address - Phone:503-525-1149
Practice Address - Fax:503-287-0212
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0984103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
111482Medicare ID - Type Unspecified