=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437308442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ELAINE BJELLAND MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2008
-----------------------------------------------------
Last Update Date | 09/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1223 OAK AVENUE
-----------------------------------------------------
City | HOOD RIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-490-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 SAMANTHA ST
-----------------------------------------------------
City | HOOD RIVER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97031-8811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-490-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L3928
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW00006850
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------