Provider Demographics
NPI:1770792350
Name:TONGEL, LISA KAREN (LAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAREN
Last Name:TONGEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NW FLANDERS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3400
Mailing Address - Country:US
Mailing Address - Phone:503-577-3669
Mailing Address - Fax:503-241-5484
Practice Address - Street 1:2330 NW FLANDERS ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-577-3669
Practice Address - Fax:503-241-5484
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR45-4499714OtherIRS
OR45-4499714OtherIRS