Provider Demographics
NPI:1629345673
Name:CERVI-SKINNER, LINDSEY LEE (LMT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:LEE
Last Name:CERVI-SKINNER
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:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-1288
Mailing Address - Country:US
Mailing Address - Phone:503-625-1808
Mailing Address - Fax:503-625-1824
Practice Address - Street 1:16455 SW LANGER DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-7706
Practice Address - Country:US
Practice Address - Phone:503-625-1808
Practice Address - Fax:503-625-1824
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist