1457368557 NPI number — MS. DEANNA ENGBER LPC

Table of content: MS. DEANNA ENGBER LPC (NPI 1457368557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457368557 NPI number — MS. DEANNA ENGBER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGBER
Provider First Name:
DEANNA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1457368557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 N ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANBY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97013-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-263-8903
Provider Business Mailing Address Fax Number:
503-266-8632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5291 NE ELAM YOUNG PKWY STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-7560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-372-5147
Provider Business Practice Location Address Fax Number:
503-640-4001
Provider Enumeration Date:
08/02/2006

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: 101YM0800X , with the licence number:  C4978 , 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: 50075974 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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