Provider Demographics
NPI:1023691276
Name:NELSON, LAKEN KRISTINE
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:KRISTINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SE VISTA TER
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8167
Mailing Address - Country:US
Mailing Address - Phone:805-550-2990
Mailing Address - Fax:
Practice Address - Street 1:18417 SE OAK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4850
Practice Address - Country:US
Practice Address - Phone:971-727-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health