Provider Demographics
NPI:1629191572
Name:RAYNOR, MICHELLE CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:RAYNOR
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 1:13280 SE MEADOWPARK DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97236-5986
Mailing Address - Country:US
Mailing Address - Phone:503-679-8292
Mailing Address - Fax:503-206-5910
Practice Address - Street 1:2015 E 12TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3912
Practice Address - Country:US
Practice Address - Phone:503-679-8292
Practice Address - Fax:503-206-5910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA20191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical