Organization
MIKALA L. SACCOMAN, PHD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKALA L SACCOMAN PHD (OWNER)
(541) 678-5174
Entity
Organization
Contact information
Practice address
497 SW CENTURY DR STE 104, BEND, OR 97702-1167
(541) 678-5174
(541) 678-5017
Mailing address
497 SW CENTURY DR STE 104, BEND, OR 97702-1167
(541) 678-5174
(541) 678-5017
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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