Healthcare Provider Details

I. General information

NPI: 1831847425
Provider Name (Legal Business Name): PAUL CHRISTOPHER LASKONIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 08/18/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 CHRISTIE DRIVE
LAKE OSWEGO OR
97034
US

IV. Provider business mailing address

PO BOX 368
MARYLHURST OR
97036-0368
US

V. Phone/Fax

Practice location:
  • Phone: 503-635-3416
  • Fax:
Mailing address:
  • Phone: 503-635-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: