Individual
MRS. LISA ANN MUNGENAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRM, PSS, THW
Contact information
Practice address
1030 NE COUCH ST, PORTLAND, OR 97232-3067
(503) 239-8400
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
107729
OR
Other
Enumeration date
02/27/2023
Last updated
05/19/2023
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