Healthcare Provider Details

I. General information

NPI: 1568583151
Provider Name (Legal Business Name): MS. LISA KAYE SIEVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 SE 43RD AVE SUITE 200
PORTLAND OR
97206-1600
US

IV. Provider business mailing address

21805 SE ALDER DR APT # 7
GRESHAM OR
97030-2451
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-9654
  • Fax:
Mailing address:
  • Phone: 503-328-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: