Provider Demographics
NPI:1508027111
Name:ZMOELNIG, TRUDE (PHD)
Entity type:Individual
Prefix:
First Name:TRUDE
Middle Name:
Last Name:ZMOELNIG
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 1:668 MCVEY AVE
Mailing Address - Street 2:123
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4853
Mailing Address - Country:US
Mailing Address - Phone:503-636-4819
Mailing Address - Fax:
Practice Address - Street 1:668 MCVEY AVE
Practice Address - Street 2:123
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-4853
Practice Address - Country:US
Practice Address - Phone:503-636-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15468 INACTIVE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist