1356489736 NPI number — MS. DONLEEN M HENDRICKS LPC, CGACII

Table of content: MS. DONLEEN M HENDRICKS LPC, CGACII (NPI 1356489736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356489736 NPI number — MS. DONLEEN M HENDRICKS LPC, CGACII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRICKS
Provider First Name:
DONLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CGACII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356489736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7532 SW BARNES RD
Provider Second Line Business Mailing Address:
#D
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97225-6235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-313-5372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 NE 19TH AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97232-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-963-2577
Provider Business Practice Location Address Fax Number:
503-239-5953
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CGAC II , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101YA0400X . This is a "CGACII" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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