Provider Demographics
NPI:1528266673
Name:ZUMBAHLEN, MARCIA R (PHD, IMHC)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:R
Last Name:ZUMBAHLEN
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Gender:F
Credentials:PHD, IMHC
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Mailing Address - Street 1:2849 SW SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3984
Mailing Address - Country:US
Mailing Address - Phone:217-369-1334
Mailing Address - Fax:888-977-2162
Practice Address - Street 1:10260 SW GREENBURG RD STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5514
Practice Address - Country:US
Practice Address - Phone:773-669-8378
Practice Address - Fax:888-977-2162
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA082604103G00000X
WAPY60941643103G00000X
OR3340103G00000X
IL071009422103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist