Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1412 | OR |
Y | 103TC0700X | Clinical Psychologist | 1412 | OR |
NPI | 1013072586 |
---|---|
Provider Name | Michelle Lee Dykstra |
First Address | Oregon City, OR 97045 |
Second Address | Oregon City, OR 97045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279270 | MHN HMC (01) |