Provider Demographics
NPI:1528689031
Name:BLUMENTHAL, DANIEL LOGUE
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LOGUE
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 NE GLISAN ST APT M
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6351
Mailing Address - Country:US
Mailing Address - Phone:510-962-2976
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST # 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6400
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health