Provider Demographics
NPI:1548440878
Name:LANCASTER, REBECCA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 SE SAINT HELENS ST STE 270A
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6801
Mailing Address - Country:US
Mailing Address - Phone:317-294-2452
Mailing Address - Fax:
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 270B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6801
Practice Address - Country:US
Practice Address - Phone:855-583-2842
Practice Address - Fax:503-678-9751
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042211A103TC0700X, 103TC0700X
OR3582103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936550Medicaid
IN200936550Medicaid