Provider Demographics
NPI:1225572761
Name:LIEN, LISA (IBCLC)
Entity Type:Individual
Prefix:MR
First Name:LISA
Middle Name:
Last Name:LIEN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 SW EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5739
Mailing Address - Country:US
Mailing Address - Phone:503-705-6081
Mailing Address - Fax:
Practice Address - Street 1:2269 SW EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5739
Practice Address - Country:US
Practice Address - Phone:503-705-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN