Healthcare Provider Details

I. General information

NPI: 1174680359
Provider Name (Legal Business Name): CONNIE LINDGREN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 DONALD ST SUITE 650
EUGENE OR
97405-4753
US

IV. Provider business mailing address

PO BOX 5294
EUGENE OR
97405-0294
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-9845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier039706
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: