Provider Demographics
NPI:1932326584
Name:DUNLAP, MICHAELE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAELE
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NW 17TH AVENUE
Mailing Address - Street 2:#11
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2327
Mailing Address - Country:US
Mailing Address - Phone:503-227-2027
Mailing Address - Fax:503-227-3836
Practice Address - Street 1:818 NW 17TH AVENUE
Practice Address - Street 2:#11
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2327
Practice Address - Country:US
Practice Address - Phone:503-227-2027
Practice Address - Fax:503-227-3836
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical