Provider Demographics
NPI:1780267161
Name:LEFCOVICH, JAIME BETH (LDM, CPM)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:BETH
Last Name:LEFCOVICH
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 NE FAILING ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3231
Mailing Address - Country:US
Mailing Address - Phone:530-401-6806
Mailing Address - Fax:971-228-1387
Practice Address - Street 1:333 NE RUSSELL ST STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3763
Practice Address - Country:US
Practice Address - Phone:530-401-6806
Practice Address - Fax:971-228-1387
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10211164176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife