Provider Demographics
NPI:1487347811
Name:PENCE, MEGHAN LUNDEEN (MA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LUNDEEN
Last Name:PENCE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2915
Mailing Address - Country:US
Mailing Address - Phone:503-989-1050
Mailing Address - Fax:
Practice Address - Street 1:19824 SW 72ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8398
Practice Address - Country:US
Practice Address - Phone:503-908-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist