Individual
TRAVIS V WONDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
17645 NW SAINT HELENS RD, PORTLAND, OR 97231-1729
(503) 621-1069
(503) 621-0200
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2969
OR
103T00000X
Psychologist
PY61384058
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106557
—
WA
05
—
500655832
—
OR
Enumeration date
07/04/2011
Last updated
09/28/2023
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