Individual
CORRISA MALAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 SE 32ND PL, PORTLAND, OR 97214-5016
(503) 234-9591
Mailing address
1715 SE 32ND PL, PORTLAND, OR 97214-5016
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
09/29/2021
Last updated
10/19/2023
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