Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 0023 | OR |
NPI | 1235341629 |
---|---|
Provider Name | Prof. Muriel D. Lezak |
First Address | Portland, OR 97201-5060 |
Second Address | Portland, OR 97201-5060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2007 |
Last Update Date | 08/07/2007 |