Individual
DR. SERITA BACKSTRAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
1791 NW 173RD AVE STE 140, BEAVERTON, OR 97006
(503) 533-9806
(503) 352-1809
Mailing address
1791 NW 173RD AVE STE 140, BEAVERTON, OR 97006-5630
(503) 533-9806
(503) 352-1809
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2933
OR
103T00000X
Psychologist
PY60776565
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
08/21/2014
Last updated
04/01/2019
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