Basic Information
| Provider Information | |||||||||
| NPI: | 1538582903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRONTEL | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | GAIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 SW 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972051999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032210161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6640 SW REDWOOD LN | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036207358 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2014 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 8833744-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 2509 | OR | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.