Provider Demographics
NPI:1437206414
Name:OZAKI, MONA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:MARIE
Last Name:OZAKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N.W. EASTMAN PARKWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3850
Mailing Address - Country:US
Mailing Address - Phone:503-318-3439
Mailing Address - Fax:503-665-3260
Practice Address - Street 1:1550 NW EASTMAN PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3858
Practice Address - Country:US
Practice Address - Phone:503-318-3439
Practice Address - Fax:503-665-3260
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0007670639Medicare UPIN
OR6077970300000Medicare UPIN
OR0001126939Medicare UPIN
ORA985622Medicare UPIN
OR121189Medicare UPIN