Provider Demographics
NPI:1366645731
Name:HISLOP, MICHELE (BA, QMHA, LMT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HISLOP
Suffix:
Gender:F
Credentials:BA, QMHA, LMT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:HISLOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:633 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3911
Mailing Address - Country:US
Mailing Address - Phone:503-560-0446
Mailing Address - Fax:
Practice Address - Street 1:435 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4628
Practice Address - Country:US
Practice Address - Phone:503-472-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 171M00000X
OR10968225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10968OtherLISENCED MASSAGE THERAPIS