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General NPI Number Information
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NPI Number | 1205428174
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Entity Type | Individual
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Provider Name | LYDIA HOGAN PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 619 MADISON ST STE 108
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City | OREGON CITY
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State | OR
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Zip | 97045-2354
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Country | US
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Telephone | 503-303-4257
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Fax |
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Provider Business Mailing Address
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Address Line | 14490 SE WY EAST AVE
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City | DAMASCUS
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State | OR
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Zip | 97089-7817
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Country | US
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Telephone | 971-221-0940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4122
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4122
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License Number State | OR
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