Provider Demographics
NPI:1750371191
Name:LABS, SHARON M (PHD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:LABS
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 1:2055 SW MOUNT HOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1561
Mailing Address - Country:US
Mailing Address - Phone:503-224-3393
Mailing Address - Fax:503-310-9333
Practice Address - Street 1:2055 SW MOUNT HOOD LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1561
Practice Address - Country:US
Practice Address - Phone:503-224-3393
Practice Address - Fax:503-310-9333
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR608103G00000X, 103T00000X, 103TC0700X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150266Medicaid