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General NPI Number Information
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NPI Number | 1730623729
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Entity Type | Organization
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Legal Business Name | A DRAGONFLY MIND, LLC
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 10260 SW GREENBURG RD STE 400
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City | PORTLAND
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State | OR
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Zip | 97223-5514
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Country | US
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Telephone | 773-669-8378
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Fax | 888-977-2162
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Provider Business Mailing Address
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Address Line | 2849 SW SPRING GARDEN ST
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City | PORTLAND
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State | OR
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Zip | 97219-3984
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Country | US
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Telephone | 217-369-1334
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Fax | 888-977-2162
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Authorized Official
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Title or Position | OWNER/CLINICAL NEUROPSYCHOLOGIST
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Name | DR. MARCIA R. ZUMBAHLEN
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Credential | PH.D.
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Telephone | 773-669-8378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 082604
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071009422
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License Number State | IL
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