Individual
MAI ROOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4039 N MISSISSIPPI AVE, SUITE 309, PORTLAND, OR 97227-1476
(503) 840-8783
Mailing address
4039 N MISSISSIPPI AVE, SUITE 309, PORTLAND, OR 97227-1476
(503) 840-8783
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2025
OR
103TC0700X
Clinical Psychologist
Primary
2025
OR
Other
Enumeration date
10/18/2006
Last updated
04/13/2016
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