Provider Demographics
NPI:1720962426
Name:PORTLAND HEALTH AND REHABILITATION PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:PORTLAND HEALTH AND REHABILITATION PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-567-4952
Mailing Address - Street 1:1110 SE ALDER ST STE 301
Mailing Address - Street 2:BOX 112
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2400
Mailing Address - Country:US
Mailing Address - Phone:503-567-4952
Mailing Address - Fax:
Practice Address - Street 1:5901 S MACADAM AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3620
Practice Address - Country:US
Practice Address - Phone:503-567-4952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty