Healthcare Provider Details

I. General information

NPI: 1154237261
Provider Name (Legal Business Name): DANA LIDA ELG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 NE STUCKI AVE
HILLSBORO OR
97006-6945
US

IV. Provider business mailing address

1707 SE LAMBERT ST
PORTLAND OR
97202-6146
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-5000
  • Fax:
Mailing address:
  • Phone: 503-348-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: