Provider Demographics
NPI:1588788772
Name:DOEMLAND, PATRICIA (OR LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:DOEMLAND
Suffix:
Gender:F
Credentials:OR LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 N 200TH ST
Mailing Address - Street 2:#404
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3147
Mailing Address - Country:US
Mailing Address - Phone:541-840-3714
Mailing Address - Fax:206-784-2739
Practice Address - Street 1:724 CARDLEY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6124
Practice Address - Country:US
Practice Address - Phone:541-840-3714
Practice Address - Fax:206-784-2739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000THLHRMedicare ID - Type UnspecifiedPROVIDER NUMBER