Provider Demographics
NPI:1790224806
Name:CORIELL, MICHELLE (CRM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CORIELL
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 SE DIVISION ST
Mailing Address - Street 2:STE. D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1372
Mailing Address - Country:US
Mailing Address - Phone:503-481-6594
Mailing Address - Fax:503-208-2596
Practice Address - Street 1:10209 SE DIVISION ST
Practice Address - Street 2:STE. D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1372
Practice Address - Country:US
Practice Address - Phone:503-481-6594
Practice Address - Fax:503-208-2596
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-CRM-019175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist