1477824779 NPI number — MRS. LISE ANNE VERHOOGEN ODDEN LPC (M.S.,M.A.)

Table of content: MRS. LISE ANNE VERHOOGEN ODDEN LPC (M.S.,M.A.) (NPI 1477824779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477824779 NPI number — MRS. LISE ANNE VERHOOGEN ODDEN LPC (M.S.,M.A.)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERHOOGEN ODDEN
Provider First Name:
LISE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC (M.S.,M.A.)
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:
1477824779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HULT PLAZA BUILDING STE 330
Provider Second Line Business Mailing Address:
401 EAST 10TH AVE.
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-868-2004
Provider Business Mailing Address Fax Number:
541-928-3020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GRANT PROFESSIONAL BUSINESS CENTER
Provider Second Line Business Practice Location Address:
887 NW GRANT AVE.
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-714-5620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2012

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 , with the licence number:  C4799 , 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)





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