Individual
COLIN SCOTT MISICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3130 SE STARK ST, PORTLAND, OR 97214-3000
(503) 535-4700
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17047
OR
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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