Healthcare Provider Details

I. General information

NPI: 1093723405
Provider Name (Legal Business Name): LANNEN EDWARD MCDONALD EDD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LANCE MCDONALD EDE

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 WILLAGILLESPIE RD #202
EUGENE OR
97401
US

IV. Provider business mailing address

975 WILLAGILLESPIE RD #202
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-7230
  • Fax: 541-343-9801
Mailing address:
  • Phone: 541-342-7230
  • Fax: 541-343-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number853
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: