Provider Demographics
NPI:1306195383
Name:PORZELIUS, LINDA KRUG (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KRUG
Last Name:PORZELIUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:KRUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:336 NE NORTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4386
Mailing Address - Country:US
Mailing Address - Phone:541-419-5860
Mailing Address - Fax:541-678-5972
Practice Address - Street 1:336 NE NORTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4386
Practice Address - Country:US
Practice Address - Phone:541-419-5860
Practice Address - Fax:541-678-5972
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist