Individual
LIDYA YIFRU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4780 SW 166TH AVE, BEAVERTON, OR 97078-1955
(206) 698-0382
Mailing address
4780 SW 166TH AVE, BEAVERTON, OR 97078-1955
(206) 698-0382
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/20/2024
Last updated
11/20/2024
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