MEDICARE: LISA ELAINE BJELLAND MSW

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	L3928	OR
2	1041C0700X	Clinical Social Worker	LW00006850	WA

General Provider Information

NPI Number	:	1437308442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ELAINE BJELLAND MSW

Provider Business Mailing Address
First Line	:	950 SAMANTHA ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-8811
Country	:	US
Telephone Number	:	541-490-3682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 OAK AVENUE
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031
Country	:	US
Telephone Number	:	541-490-3682
Fax Number	:

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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