Provider Demographics
NPI:1821424326
Name:PFEIFFER, JOHN LYLE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LYLE
Last Name:PFEIFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-239-8407
Practice Address - Street 1:10362 SW MCDONALD ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4863
Practice Address - Country:US
Practice Address - Phone:503-624-0312
Practice Address - Fax:503-639-3973
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2021-05-27
Deactivation Date:2021-01-14
Deactivation Code:
Reactivation Date:2021-03-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst