MEDICARE: ELIZABETH BODENNER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477194181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BODENNER

Provider Business Mailing Address
First Line	:	9133 N ALLEGHENY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203-2303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 NE OREGON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-4300
Country	:	US
Telephone Number	:	971-319-4827
Fax Number	:	503-662-6221

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

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	12/10/2025

Similar Medicare Providers

1578428744 — BEARNARD ROEDER
Practice Location Address:

6011 NE OREGON ST
PORTLAND, OR
97213-4300

Practice Phone: 971-319-4827
Practice Fax:

1417917246 — MS. HEIDI JOLSON MA LPC NCC CADC I
Practice Location Address:

4300 NE FREMONT ST STE 260
PORTLAND, OR
97213-1100

Practice Phone: 503-709-0456
Practice Fax: 503-334-1529

1023066214 — MRS. AMY MICHELLE CONNOLLY LPC
Practice Location Address:

4300 NE FREMONT ST STE 260
PORTLAND, OR
97213-1100

Practice Phone: 503-866-3971
Practice Fax:

1780844332 — TARA C O'CONNOR ARNP
Practice Location Address:

4300 NE FREMONT ST STE 260
PORTLAND, OR
97213-1100

Practice Phone: 816-974-7570
Practice Fax: 888-301-1226

1386085470 — ZAIDA NATALI GOMEZ LMFT
Practice Location Address:

4300 NE FREMONT ST STE 260
PORTLAND, OR
97213-1100

Practice Phone: 503-208-4607
Practice Fax:

1538599725 — SARAH POULISSE MSW
Practice Location Address:

6011 NE OREGON ST
PORTLAND, OR
97213-4300

Practice Phone: 971-319-4827
Practice Fax:

Directions to “ ELIZABETH BODENNER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.