Individual
KUSHANTHI SURINI SAMARATUNGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
7455 SW BEVELAND RD, TIGARD, OR 97223-8610
(503) 624-2600
(503) 624-7752
Mailing address
7455 SW BEVELAND RD, TIGARD, OR 97223-8610
(503) 624-2600
(503) 624-7752
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2628
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210855
—
OR
Enumeration date
04/10/2008
Last updated
07/22/2015
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