Basic Information
Provider Information
NPI: 1982954632
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOPNESS
FirstName: ELLEN
MiddleName: LINNEA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8459
Address2:  
City: PORTLAND
State: OR
PostalCode: 972078459
CountryCode: US
TelephoneNumber: 5032380769
FaxNumber:  
Practice Location
Address1: 9111 NE SUNDERLAND AVE
Address2:  
City: PORTLAND
State: OR
PostalCode: 972111708
CountryCode: US
TelephoneNumber: 5032806646
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2012
LastUpdateDate: 09/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home