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DR. KEVIN FREDERICK MALLON PH.D.

Clinical Neuropsychologist

Hillsboro, Oregon

Provider NPI: 1417930009

Provider Information:
DR. KEVIN FREDERICK MALLON PH.D.
Gender: M
Not Sole Proprietor

Practice Location:
1925 NW AMBERGLEN PKWY SUITE 300 HILLSBORO, OR 97006 US
Tel: 503-906-5019  Fax: 503-906-5193

Business Mailing Address:
PO BOX 1034 (PORTLAND VAMC - HILLS CBOC) PORTLAND, OR 97207 US
Tel: 503-906-5019  Fax: 503-906-5193

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
CAPSY13735
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
CAPSY13735
Y103TH0004XBehavioral Health & Social Service Providers
Psychologist
CAPSY 13735

Other Provider Identifiers:

IssuerNumberStateType
OPL13735004
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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