Individual
MICHELLE LYNN CRADIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSS
Contact information
Practice address
640 NE 3RD ST, MCMINNVILLE, OR 97128-4630
(503) 474-5509
Mailing address
239 SE BAKER ST, UNIT B, MCMINNVILLE, OR 97128-6076
(971) 241-5831
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000001779
OREGON HEALTH AUTHORITY
OR
Enumeration date
11/18/2019
Last updated
11/18/2019
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