Individual
MAIR MARSIGLIO JETMALANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
1516 NE HANCOCK ST, APT 207, PORTLAND, OR 97212-4474
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2534
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500765636
—
OR
Enumeration date
08/03/2015
Last updated
04/19/2023
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