Individual
SUSAN MARIE STORMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
916 SW KING AVE STE 203, PORTLAND, OR 97205-1320
(503) 902-5000
Mailing address
7327 SW BARNES RD # 420, PORTLAND, OR 97225-6119
(503) 902-5000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2800
OR
103TC0700X
Clinical Psychologist
31450
TX
103TC0700X
Clinical Psychologist
PY61341034
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145683205
—
TX
05
—
145683206
—
TX
01
—
86814A
BCBS
TX
01
—
86815A
BCBS
TX
01
—
P00009482
RAILROAD
TX
01
—
P00009483
RAILROAD
TX
Enumeration date
06/01/2006
Last updated
12/09/2022
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