Provider Demographics
NPI:1376762955
Name:LANCASTER, BONNIE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 AARON WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1770
Mailing Address - Country:US
Mailing Address - Phone:503-538-9493
Mailing Address - Fax:
Practice Address - Street 1:170 AARON WAY
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1770
Practice Address - Country:US
Practice Address - Phone:503-538-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist