Provider Demographics
NPI:1821556556
Name:LEE, WYNONA ELVERA
Entity Type:Individual
Prefix:MISS
First Name:WYNONA
Middle Name:ELVERA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 NW GREENBRIER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7359
Mailing Address - Country:US
Mailing Address - Phone:503-258-4512
Mailing Address - Fax:503-350-0415
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7359
Practice Address - Country:US
Practice Address - Phone:503-258-4512
Practice Address - Fax:503-350-0415
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA12728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker