Individual
DR. ELISA A RUDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2400 SW VERMONT ST, PORTLAND, OR 97219-1940
(503) 853-1196
Mailing address
255 NW 116TH AVE APT 402, PORTLAND, OR 97229-6099
(503) 853-1196
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R185947
MEDICARE PTAN
OR
Enumeration date
02/19/2014
Last updated
04/05/2016
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