Basic Information
| Provider Information | |||||||||
| NPI: | 1134342587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTERGARD | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | CARI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, PHD, PC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3990 COLLINS WAY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970353480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036752830 | ||||||||
| FaxNumber: | 5036752852 | ||||||||
| Practice Location | |||||||||
| Address1: | 3990 COLLINS WAY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970353480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036752830 | ||||||||
| FaxNumber: | 5036752852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 2106 | OR | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | R138282 | 01 | OR | MEDICARE PTAN-GROUP | OTHER | R161082 | 01 | OR | MEDICARE PTAN-INDIVIDUAL | OTHER |