Provider Demographics
NPI:1528679339
Name:KALILNOWSKI, LISA MARIE (CADC1)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:KALILNOWSKI
Suffix:
Gender:M
Credentials:CADC1
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:KALINOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDAC1
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:503-239-8400
Mailing Address - Fax:503-239-8407
Practice Address - Street 1:2367 S ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-6550
Practice Address - Country:US
Practice Address - Phone:971-320-3130
Practice Address - Fax:503-738-2116
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)