Basic Information
| Provider Information | |||||||||
| NPI: | 1477631703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SASKIA HOSTETLER LIPPY, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3439 NE SANDY BLVD PMB 375 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972321959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032848841 | ||||||||
| FaxNumber: | 5032823302 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 SW 11TH AVE | ||||||||
| Address2: | STE 250 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972052125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032415253 | ||||||||
| FaxNumber: | 5032415559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 11/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | HOSTETLER LIPPY | ||||||||
| AuthorizedOfficialFirstName: | SASKIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5032415253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD24355 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.