Provider Demographics
NPI:1811132053
Name:NIKUNEN, LISA ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:NIKUNEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 NW MURRAY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5568
Mailing Address - Country:US
Mailing Address - Phone:503-671-0520
Mailing Address - Fax:503-671-0520
Practice Address - Street 1:1070 NW MURRAY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5568
Practice Address - Country:US
Practice Address - Phone:503-671-0520
Practice Address - Fax:503-671-0520
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1316103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist