Individual
DR. BENJAMIN R BOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948
(541) 726-1465
Mailing address
3995 MARCOLA RD, SPRINGFIELD, OR 97477-7948
(541) 726-1465
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2142
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142
STATE PSYCHOLOGIST LICENSE
OR
Enumeration date
01/09/2007
Last updated
11/12/2010
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