Individual
ELISE NOEL BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1551 PEARL ST, EUGENE, OR 97401-4010
(541) 517-9733
Mailing address
1551 PEARL ST, EUGENE, OR 97401-4010
(541) 517-9733
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3154
OR
Other
Enumeration date
10/23/2019
Last updated
02/15/2023
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