MEDICARE: MICHELLE JACQUELINE BLUM MSSW, LCSW

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
1	1041C0700X	Clinical Social Worker	3010	OR

General Provider Information

NPI Number	:	1851408272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JACQUELINE BLUM MSSW, LCSW

Provider Business Mailing Address
First Line	:	1916 NE 63RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-4710
Country	:	US
Telephone Number	:	971-361-6330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 SE ALDER ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2400
Country	:	US
Telephone Number	:	971-361-6330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/24/2020

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