Provider Demographics
NPI:1518170760
Name:PRESCOTT, ALISON (PHD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4030
Mailing Address - Country:US
Mailing Address - Phone:541-686-4226
Mailing Address - Fax:541-683-3133
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-686-4226
Practice Address - Fax:541-683-3133
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1123103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079793Medicare ID - Type UnspecifiedPROVIDER NUMBER