Provider Demographics
NPI:1275801417
Name:TOBECK, LORRAINE JANET (LMT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:JANET
Last Name:TOBECK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11632 SE LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3655
Mailing Address - Country:US
Mailing Address - Phone:503-239-4785
Mailing Address - Fax:503-258-8648
Practice Address - Street 1:3515 NE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1013
Practice Address - Country:US
Practice Address - Phone:503-239-4785
Practice Address - Fax:503-258-8648
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist