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General NPI Number Information
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NPI Number | 1164133427
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Entity Type | Organization
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Legal Business Name | MICHAELA GRILLO LLC
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 942 WINDEMERE DR NW
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City | SALEM
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State | OR
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Zip | 97304
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Country | US
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Telephone | 503-482-9089
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Fax | 971-339-7115
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Provider Business Mailing Address
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Address Line | 3055 NW YEON AVE # 866
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City | PORTLAND
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State | OR
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Zip | 97210-1519
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Country | US
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Telephone | 503-482-9089
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Fax | 971-339-7115
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Authorized Official
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Title or Position | OWNER
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Name | MICHAELA GRILLO
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Credential | LCSW
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Telephone | 978-790-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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