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General NPI Number Information
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NPI Number | 1235120817
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Entity Type | Individual
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Provider Name | LIANNE CAROLE LENNERT PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4900 SW GRIFFITH DR STE 235
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City | BEAVERTON
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State | OR
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Zip | 97005-5607
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Country | US
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Telephone | 503-539-4654
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Fax | 503-641-1601
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Provider Business Mailing Address
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Address Line | 915 NW 87TH AVE
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City | PORTLAND
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State | OR
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Zip | 97229-6462
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Country | US
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Telephone | 503-203-6845
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1538
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License Number State | OR
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