Healthcare Provider Details

I. General information

NPI: 1114607868
Provider Name (Legal Business Name): LIANNE MCLANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 300
GRESHAM OR
97030-3725
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 300
GRESHAM OR
97030-3725
US

V. Phone/Fax

Practice location:
  • Phone: 206-437-7257
  • Fax:
Mailing address:
  • Phone: 206-437-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

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: