=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467909861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA HARMAN B.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2016
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22018 S CENTRAL POINT RD
-----------------------------------------------------
City | CANBY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97013-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-343-9929
-----------------------------------------------------
Fax | 503-263-6278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22018 S CENTRAL POINT RD
-----------------------------------------------------
City | CANBY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97013-8705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-343-9929
-----------------------------------------------------
Fax | 503-263-6278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------