Provider Demographics
NPI:1639042716
Name:VILLAVICENCIO-MORRISON, BLANCHETTE
Entity type:Individual
Prefix:MRS
First Name:BLANCHETTE
Middle Name:
Last Name:VILLAVICENCIO-MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4677
Mailing Address - Country:US
Mailing Address - Phone:503-238-1512
Mailing Address - Fax:541-444-8325
Practice Address - Street 1:3220 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4677
Practice Address - Country:US
Practice Address - Phone:503-238-1512
Practice Address - Fax:541-444-8325
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker