Individual
DR. CHERYL ANNE GIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
(541) 687-9041
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
(541) 687-9041
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1309
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181430
—
OR
01
—
825411000
REGENCE BCBS PROV. #
OR
01
—
J6460 01
PACIFICSOURCE INS. PROV.
OR
Enumeration date
08/31/2005
Last updated
09/17/2021
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