Provider Demographics
NPI:1386312700
Name:TYLER, MICHELLE (CASE MANAGER)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 NE GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2094
Mailing Address - Country:US
Mailing Address - Phone:503-528-2140
Mailing Address - Fax:503-335-8125
Practice Address - Street 1:3655 NE GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2094
Practice Address - Country:US
Practice Address - Phone:503-528-2140
Practice Address - Fax:503-335-8125
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator