Individual
ELIZABETH ANNE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1910
OR
Other
Enumeration date
10/19/2012
Last updated
03/07/2013
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