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NPI Code Detail

MEDICARE: LAUREL FUSON-LANG PSYD

MEDICARE: LAUREL FUSON-LANG PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist3512OR

General Provider Information

NPI Number : 1700268067
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL FUSON-LANG PSYD
Provider Business Mailing Address
First Line : 1517 16TH ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1773
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 905 SE 14TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2569
Country : US
Telephone Number : 503-622-8964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2015
Last Update Date : 06/04/2026

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Directions to “ LAUREL FUSON-LANG PSYD” Practice Location

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