Marrissa Gottlob
Mental Health
421 Sw Oak St
Portland
, Oregon 97204-1817
Marrissa Gottlob
Mental Health
421 Sw Oak St
Portland
, Oregon 97204-1817
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About
Features
Specialties
- Mental Health
Languages spoken
- English
Location
First Address
- Marrissa Gottlob
- 14600 Nw Cornell Rd
- Portland, OR
- Zip : 97229-5442
- Phone :
Second Address
- Marrissa Gottlob
- 421 Sw Oak St
- Portland, OR
- Zip : 97204-1817
- Phone : (503) 988-3999
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225XM0800X | Mental Health |
National Provider Identifier
| NPI | 1134480593 |
|---|---|
| Provider Name | Marrissa Gottlob |
| First Address | Portland, OR 97229-5442 |
| Second Address | Portland, OR 97204-1817 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/06/2012 |
| Last Update Date | 01/06/2012 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.