Individual
DR. ROBERT BRADLEY BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1312 SW 16TH AVENUE, SUITE 102, PORTLAND, OR 97201-2620
(503) 242-2533
(503) 220-8860
Mailing address
1312 SW 16TH AVENUE, SUITE 102, PORTLAND, OR 97201-2620
(503) 242-2533
(503) 220-8860
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
677
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172718
—
OR
Enumeration date
07/18/2006
Last updated
08/17/2009
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