Provider Demographics
NPI:1144976051
Name:ROS, LISA MARIE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ROS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 NE 47TH AVE APT 417
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2092
Mailing Address - Country:US
Mailing Address - Phone:971-803-9305
Mailing Address - Fax:
Practice Address - Street 1:110 WARNER MILNE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4042
Practice Address - Country:US
Practice Address - Phone:971-803-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health