Healthcare Provider Details

I. General information

NPI: 1659236131
Provider Name (Legal Business Name): LEE ANN LANDPHAIR LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

IV. Provider business mailing address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-6000
  • Fax: 503-352-6081
Mailing address:
  • Phone: 503-352-6000
  • Fax: 503-352-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberR12468
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: