Healthcare Provider Details

I. General information

NPI: 1134345713
Provider Name (Legal Business Name): LINDA TOENNIESSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 SW 10TH AVE SUITE 604
PORTLAND OR
97205-2732
US

IV. Provider business mailing address

511 SW 10TH AVE SUITE 604
PORTLAND OR
97205-2732
US

V. Phone/Fax

Practice location:
  • Phone: 503-232-1418
  • Fax: 503-234-7166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD11964
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: