Provider Demographics
NPI:1083157416
Name:KNUDSEN, LISA PAULINE (LPC, CADCII)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PAULINE
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:LPC, CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20512 SW ROY ROGERS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9929
Mailing Address - Country:US
Mailing Address - Phone:503-341-2694
Mailing Address - Fax:
Practice Address - Street 1:20512 SW ROY ROGERS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-341-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03-03-60101YA0400X
ORC4979101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)