Individual
STACI WADE-HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
5000 N WILLAMETTE BLVD, MSC 147, PORTLAND, OR 97203-5743
(541) 737-2131
Mailing address
5000 N WILLAMETTE BLVD, MSC 147, PORTLAND, OR 97203-5743
(503) 943-7134
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2283
OR
Other
Enumeration date
04/28/2015
Last updated
03/14/2016
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