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NPI Code Detail

MEDICARE: DR. MARCIA R. ZUMBAHLEN PH.D., IMHC

MEDICARE: DR. MARCIA R. ZUMBAHLEN PH.D., IMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical Neuropsychologist082604IA
2103G00000XClinical NeuropsychologistPY60941643WA
3103G00000XClinical Neuropsychologist3340OR
4103G00000XClinical Neuropsychologist071009422IL

General Provider Information

NPI Number : 1528266673
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCIA R. ZUMBAHLEN PH.D., IMHC
Provider Business Mailing Address
First Line : 2849 SW SPRING GARDEN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97219-3984
Country : US
Telephone Number : 217-369-1334
Fax Number : 888-977-2162
Provider Business Practice Location Address
First Line : 10260 SW GREENBURG RD STE 400
Second Line :
City : PORTLAND
State : OR
Zip : 97223-5514
Country : US
Telephone Number : 773-669-8378
Fax Number : 888-977-2162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 11/08/2021

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