Healthcare Provider Details

I. General information

NPI: 1437308442
Provider Name (Legal Business Name): LISA ELAINE BJELLAND MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 OAK AVENUE
HOOD RIVER OR
97031
US

IV. Provider business mailing address

950 SAMANTHA ST
HOOD RIVER OR
97031-8811
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-3682
  • Fax:
Mailing address:
  • Phone: 541-490-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3928
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00006850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: