Individual
PETRA ZDENKOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3640 NW SAMARITAN DR STE 220, CORVALLIS, OR 97330-3784
(541) 768-5300
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2747
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2747
LICENSE NUMBER
OR
Enumeration date
08/27/2014
Last updated
12/30/2022
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