Individual
MS. MICHELLE MARIE BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3009 NE 65TH AVE, PORTLAND, OR 97213-4533
(503) 732-0055
Mailing address
3009 NE 65TH AVE, PORTLAND, OR 97213-4533
(503) 475-1486
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2565
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2012
Last updated
02/15/2022
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