MEDICARE: ALLYSON LESLIE KLEIN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS20815	CA
2	1041C0700X	Clinical Social Worker	L10203	OR

General Provider Information

NPI Number	:	1134280431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON LESLIE KLEIN L.C.S.W.

Provider Business Mailing Address
First Line	:	4146 LAKEVIEW BLVD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5551
Country	:	US
Telephone Number	:	503-832-4509
Fax Number	:

Provider Business Practice Location Address
First Line	:	4146 LAKEVIEW BLVD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5551
Country	:	US
Telephone Number	:	503-832-4509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/06/2024

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