Individual
DR. SUSAN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4915 N INTERSTATE AVE, PORTLAND, OR 97217-3624
(503) 705-3852
Mailing address
4915 N INTERSTATE AVE, PORTLAND, OR 97217-3624
(503) 705-3852
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
749
OR
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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