Individual
CHRISTOPHER BLAINE MIKULIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
4004 KRUSE WAY PL STE 300, LAKE OSWEGO, OR 97035-2479
(503) 216-1500
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3693
OR
Other
Enumeration date
05/07/2018
Last updated
02/02/2024
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