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Organization
CHILDREN'S PROGRAM
Active
Organization
CHILDREN'S PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINDY J RANIK M.S. (CLINIC COORDINATOR)
(503) 452-8002
Entity
Organization
Contact information
Practice address
7707 SW CAPITOL HWY, PORTLAND, OR 97219-2458
(503) 452-8002
Mailing address
7707 SW CAPITOL HWY, PORTLAND, OR 97219-2458
(503) 452-8002
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
OR
103TC0700X
Clinical Psychologist
—
OR
103TC2200X
Clinical Child & Adolescent Psychologist
—
OR
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
OR
2084P0804X
Child & Adolescent Psychiatry Physician
—
OR
Other
Enumeration date
12/06/2006
Last updated
09/11/2025
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