Provider Demographics
NPI:1033356993
Name:MCNALLY, LISKA NOELLE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISKA
Middle Name:NOELLE
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 SW 38TH PL
Mailing Address - Street 2:APARTMENT #47
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3851
Mailing Address - Country:US
Mailing Address - Phone:503-452-4078
Mailing Address - Fax:
Practice Address - Street 1:5131 SW 38TH PL
Practice Address - Street 2:APARTMENT #47
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-3851
Practice Address - Country:US
Practice Address - Phone:503-452-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08445171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator