Healthcare Provider Details

I. General information

NPI: 1366424681
Provider Name (Legal Business Name): LUAHNA UDE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 NW 21ST AVE
PORTLAND OR
97209-1513
US

IV. Provider business mailing address

1133 NW 21ST AVE
PORTLAND OR
97209-1513
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-5010
  • Fax: 503-224-9876
Mailing address:
  • Phone: 503-222-5010
  • Fax: 503-224-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0393
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0986
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: