Provider Demographics
NPI:1003224205
Name:CICHON, NELLIE (CADC 1)
Entity Type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:
Last Name:CICHON
Suffix:
Gender:F
Credentials:CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5915
Mailing Address - Country:US
Mailing Address - Phone:503-245-6262
Mailing Address - Fax:503-245-6263
Practice Address - Street 1:8202 N DENVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6624
Practice Address - Country:US
Practice Address - Phone:503-285-3200
Practice Address - Fax:503-245-6263
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-04-02103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy