Healthcare Provider Details

I. General information

NPI: 1134590607
Provider Name (Legal Business Name): LINDEGARD THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 SW HAMILTON CT
PORTLAND OR
97239-1216
US

IV. Provider business mailing address

2648 SW HAMILTON CT
PORTLAND OR
97239-1216
US

V. Phone/Fax

Practice location:
  • Phone: 503-913-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18085
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12129083
License Number StateOR

VIII. Authorized Official

Name: DAVID GARDER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 503-913-0404