Provider Demographics
NPI:1962610006
Name:LIN, MARIKO MEDALLADA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIKO
Middle Name:MEDALLADA
Last Name:LIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E 8TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2709
Mailing Address - Country:US
Mailing Address - Phone:608-217-8530
Mailing Address - Fax:541-632-8328
Practice Address - Street 1:313 E 8TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2709
Practice Address - Country:US
Practice Address - Phone:608-217-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2251103TC1900X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling