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Organization
PORTLAND NEURODIVERGENT CLINIC LLC
Active
Organization
PORTLAND NEURODIVERGENT CLINIC LLC
Active
Other names
Portland Neurodivergent Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA FALLON MIASNIKOV (OWNER/CLINICAL DIRECTOR)
(971) 202-0047
Entity
Organization
Contact information
Practice address
1250 NW KEARNEY ST APT 1306, PORTLAND, OR 97209-4083
(971) 202-0047
Mailing address
1250 NW KEARNEY ST APT 1306, PORTLAND, OR 97209-4083
(971) 202-0047
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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