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General NPI Number Information
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NPI Number | 1235148610
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Entity Type | Individual
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Provider Name | MRS. LILA MCQUEEN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1711 S MAIN ST
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City | LEBANON
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State | OR
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Zip | 97355-3111
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Country | US
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Telephone | 541-259-5400
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Fax | 541-259-5499
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Provider Business Mailing Address
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Address Line | 41441 MCQUEEN DR
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City | SWEET HOME
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State | OR
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Zip | 97386-9661
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 666
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License Number State | OR
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