Healthcare Provider Details

I. General information

NPI: 1710092176
Provider Name (Legal Business Name): HOLLY J MOORE-LOHMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 FALCON CREST DR # 200
REDMOND OR
97756-5014
US

IV. Provider business mailing address

7515 FALCON CREST DR # 200
REDMOND OR
97756-5014
US

V. Phone/Fax

Practice location:
  • Phone: 541-904-5216
  • Fax: 541-527-4347
Mailing address:
  • Phone: 541-904-5216
  • Fax: 541-527-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: