Provider Demographics
NPI:1942377395
Name:LISONBEE, JAN (PHD-PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:LISONBEE
Suffix:
Gender:F
Credentials:PHD-PSYCHOLOGIST
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 STREET, SUITE 1020
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:503-295-3606
Mailing Address - Fax:503-241-4727
Practice Address - Street 1:516 SE MORRISON STREET, SUITE 1020
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-295-3606
Practice Address - Fax:503-241-4727
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist