Provider Demographics
NPI:1689305997
Name:BUFFIE, MICHELLE LYN (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYN
Last Name:BUFFIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYN
Other - Last Name:ERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14607 SE CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-5390
Mailing Address - Country:US
Mailing Address - Phone:320-808-9537
Mailing Address - Fax:
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-276-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist