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Individual

DR. LISA ANNE SCHIMMEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1130 SW MORRISON ST, SUITE 619, PORTLAND, OR 97205-2234
(503) 381-9524
(855) 714-4323
Mailing address
1631 NE BROADWAY ST, PMB 738, PORTLAND, OR 97232-1425
(503) 381-9524
(855) 714-4323

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1709
OR
103TC0700X
Clinical Psychologist
PSY 15072
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
178132
MHN
CA
01
OPL150720
BLUESHIELD OF CALIFORNIA
CA
01
PSY 15072
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
08/31/2006
Last updated
06/25/2012
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