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General NPI Number Information
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NPI Number | 1750243176
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Entity Type | Organization
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Legal Business Name | OREGON LIGHTNING YOUTH INITIATIVE INCORPORATED
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 616 SW EVERGREEN AVE
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City | REDMOND
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State | OR
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Zip | 97756-2240
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Country | US
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Telephone | 971-227-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 521 SW 6TH ST STE 100
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City | REDMOND
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State | OR
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Zip | 97756-2702
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Country | US
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Telephone | 971-227-6815
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | GWENDOLYN NICOLE PEELER
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Credential |
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Telephone | 214-972-7781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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