Provider Demographics
NPI:1326475021
Name:WEEKS, LYDIA LORRAINE (LMT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LORRAINE
Last Name:WEEKS
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 1:3605 SE 166TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1521
Mailing Address - Country:US
Mailing Address - Phone:971-400-5965
Mailing Address - Fax:
Practice Address - Street 1:15351 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9667
Practice Address - Country:US
Practice Address - Phone:971-400-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist