Provider Demographics
NPI:1093723405
Name:MCDONALD, LANNEN EDWARD (EDD PC)
Entity Type:Individual
Prefix:DR
First Name:LANNEN
Middle Name:EDWARD
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:EDD PC
Other - Prefix:DR
Other - First Name:LANCE
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDE
Mailing Address - Street 1:975 WILLAGILLESPIE RD
Mailing Address - Street 2:#202
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-342-7230
Mailing Address - Fax:541-343-9801
Practice Address - Street 1:975 WILLAGILLESPIE RD
Practice Address - Street 2:#202
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-342-7230
Practice Address - Fax:541-343-9801
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR853103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral