Provider Demographics
NPI:1184756769
Name:DRUCKER, LEE S (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:DRUCKER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 S.W. BARNES ROAD, #125
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6119
Mailing Address - Country:US
Mailing Address - Phone:503-501-6320
Mailing Address - Fax:503-521-7041
Practice Address - Street 1:878 S.W. SHAKER PLACE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6151
Practice Address - Country:US
Practice Address - Phone:503-501-6320
Practice Address - Fax:503-521-7041
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHNMMedicare ID - Type UnspecifiedPSYCHOLOGIST