Basic Information
| Provider Information | |||||||||
| NPI: | 1174987911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAU | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 SPRINGHILL DR | ||||||||
| Address2: | |||||||||
| City: | GLADSTONE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970271225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036570293 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8915 SW CENTER ST | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972236307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037263740 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.