Provider Demographics
NPI:1104320266
Name:LOVEGREN, REESE ELEANOR (RPSGT, CCSH, RST)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:ELEANOR
Last Name:LOVEGREN
Suffix:
Gender:F
Credentials:RPSGT, CCSH, RST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 SW LIZ PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6250
Mailing Address - Country:US
Mailing Address - Phone:971-221-8770
Mailing Address - Fax:
Practice Address - Street 1:2875 NW STUCKI AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:971-310-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator