Active NPI
Michelle Engblom-Deglmann, LMFT
- Marriage & Family Therapist
- Tualatin, OR
National Provider Identifier
1366035172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- T1004
- Practice address
- 19824 SW 72ND Ave Ste 102
Tualatin, OR 97062-8398 - Phone
- (503) 610-3676
- NPI assigned
- Feb 12, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | T1004 | OR | Primary |
Addresses
Primary practice location
19824 SW 72ND Ave Ste 102
Tualatin, OR 97062-8398
Mailing address
4213 Riverview Dr
West Linn, OR 97068-3605
Phone (314) 749-0729
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T1004 | OR | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1366035172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4213 RIVERVIEW DR",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970683605",
"telephone_number": "314-749-0729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19824 SW 72ND AVE STE 102",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970628398",
"telephone_number": "503-610-3676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGBLOM-DEGLMANN",
"first_name": "MICHELLE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-12",
"last_updated": "2021-02-12",
"certification_date": "2021-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OR",
"license": "T1004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tualatin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.