1144381682 NPI number — MS. LYDIA D. BYHARDT BOLLINGER L.C.S.W.

Table of content: MS. LYDIA D. BYHARDT BOLLINGER L.C.S.W. (NPI 1144381682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144381682 NPI number — MS. LYDIA D. BYHARDT BOLLINGER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYHARDT BOLLINGER
Provider First Name:
LYDIA
Provider Middle Name:
D.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BYHARDT
Provider Other First Name:
LYDIA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144381682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1980 WILLAMETTE FALLS DR STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LINN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97068-4670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-409-5613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 WILLAMETTE FALLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LINN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97068-4544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-409-5613
Provider Business Practice Location Address Fax Number:
503-723-5112
Provider Enumeration Date:
12/12/2006

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: 1041C0700X , with the licence number:  3452 , 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: 3452 . This is a "LCSW" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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