Healthcare Provider Details

I. General information

NPI: 1659601961
Provider Name (Legal Business Name): MICHAEL FREDERICK HOHN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 SW MACADAM AVE SUITE 260
PORTLAND OR
97239-3768
US

IV. Provider business mailing address

5520 SW MACADAM AVE SUITE 260
PORTLAND OR
97239-3768
US

V. Phone/Fax

Practice location:
  • Phone: 971-212-6576
  • Fax: 503-206-8920
Mailing address:
  • Phone: 971-212-6576
  • Fax: 503-206-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1239
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1239
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1239
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: