Basic Information
| Provider Information | |||||||||
| NPI: | 1134434491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENNEN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16308 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972920308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
| FaxNumber: | 5032552344 | ||||||||
| Practice Location | |||||||||
| Address1: | 10011 SE DIVISION ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032552343 | ||||||||
| FaxNumber: | 5032552344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2010 | ||||||||
| LastUpdateDate: | 11/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2197 | OR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.