Provider Demographics
NPI:1053686774
Name:NEUMANN, LAURA A
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:NEUMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5604
Mailing Address - Country:US
Mailing Address - Phone:503-841-4216
Mailing Address - Fax:503-661-4959
Practice Address - Street 1:400 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5604
Practice Address - Country:US
Practice Address - Phone:503-841-4216
Practice Address - Fax:503-661-4959
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-03-31101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)