Provider Demographics
NPI:1588316236
Name:BLANDING, DINISHA MARISSA (PSYD)
Entity type:Individual
Prefix:
First Name:DINISHA
Middle Name:MARISSA
Last Name:BLANDING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SW YAMHILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1335
Mailing Address - Country:US
Mailing Address - Phone:503-946-9036
Mailing Address - Fax:
Practice Address - Street 1:520 SW YAMHILL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1335
Practice Address - Country:US
Practice Address - Phone:503-946-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist