Individual
MARY KAY AUGUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
10200 NW ALDER GROVE LN, PORTLAND, OR 97229-7584
(240) 409-5798
Mailing address
10200 NW ALDER GROVE LN, PORTLAND, OR 97229-7584
(240) 409-5798
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
02183
MD
103T00000X
Psychologist
Primary
1810
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48341
MAMSI
MD
Enumeration date
06/09/2005
Last updated
07/08/2007
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