Healthcare Provider Details

I. General information

NPI: 1376762955
Provider Name (Legal Business Name): BONNIE LYNN LANCASTER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 AARON WAY
NEWBERG OR
97132-1770
US

IV. Provider business mailing address

170 AARON WAY
NEWBERG OR
97132-1770
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-9493
  • Fax:
Mailing address:
  • Phone: 503-538-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1541
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: