Healthcare Provider Details

I. General information

NPI: 1336064641
Provider Name (Legal Business Name): NAILA LUNDSTROM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW DURHAM RD
TIGARD OR
97224-5539
US

IV. Provider business mailing address

9700 SW MARILYN CT
TIGARD OR
97224-5705
US

V. Phone/Fax

Practice location:
  • Phone: 503-431-5494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18180
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: