Provider Demographics
NPI:1790209955
Name:LAUER, KRISTEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LAUER
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 1:516 SE MORRISON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2344
Mailing Address - Country:US
Mailing Address - Phone:971-242-8894
Mailing Address - Fax:
Practice Address - Street 1:516 SE MORRISON ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2344
Practice Address - Country:US
Practice Address - Phone:971-242-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3079103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist