Provider Demographics
NPI:1144381682
Name:BYHARDT BOLLINGER, LYDIA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:D
Last Name:BYHARDT BOLLINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:D
Other - Last Name:BYHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1980 WILLAMETTE FALLS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4670
Mailing Address - Country:US
Mailing Address - Phone:971-409-5613
Mailing Address - Fax:
Practice Address - Street 1:1609 WILLAMETTE FALLS DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4544
Practice Address - Country:US
Practice Address - Phone:971-409-5613
Practice Address - Fax:503-723-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR34521041C0700X
ORL34521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3452OtherLCSW