Provider Demographics
NPI:1982755716
Name:RAVENSBERG, VICTORIA JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:JANE
Last Name:RAVENSBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 SW PACIFIC HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4890
Mailing Address - Country:US
Mailing Address - Phone:503-536-3855
Mailing Address - Fax:503-670-1034
Practice Address - Street 1:14050 SW PACIFIC HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4890
Practice Address - Country:US
Practice Address - Phone:503-536-3855
Practice Address - Fax:503-670-1034
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical