Provider Demographics
NPI:1740329390
Name:THOMPSON, ROBERT J (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:THOMPSON
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 1:9900 SW GREENBURG RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5502
Mailing Address - Country:US
Mailing Address - Phone:503-670-0111
Mailing Address - Fax:503-670-8052
Practice Address - Street 1:9900 SW GREENBURG RD
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5502
Practice Address - Country:US
Practice Address - Phone:503-670-0111
Practice Address - Fax:503-670-8052
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0630103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent