Individual
MRS. JONI MARIE MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
502 N MAIN AVE, GRESHAM, OR 97030-7236
(503) 891-0749
Mailing address
2700 SW CORBETH LN, TROUTDALE, OR 97060-3140
(503) 891-0749
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1637
OR
103TC0700X
Clinical Psychologist
Primary
1637
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
09/29/2006
Last updated
02/27/2025
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