Provider Demographics
NPI:1700138211
Name:VAZQUEZ, VERONICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:VAZQUEZ
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 1:0224 SW HAMILTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6418
Mailing Address - Country:US
Mailing Address - Phone:503-804-9900
Mailing Address - Fax:
Practice Address - Street 1:0224 SW HAMILTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6418
Practice Address - Country:US
Practice Address - Phone:503-804-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2241103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist