Lane Dewan, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1949 Issued in OR

Practice address

11575 SW Pacific Hwy # 1031
Tigard, OR 97223-8671

Phone

(503) 395-5122

NPI assigned

Apr 5, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 13, 2023 through Dec 13, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• LWD Psychology LLC

  • Clinical Psychologist
  • Tigard, OR
  • NPI 1083327308
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1174848022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11575 SW PACIFIC HWY # 1031",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238671",
            "telephone_number": "503-395-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11575 SW PACIFIC HWY # 1031",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238671",
            "telephone_number": "503-395-5122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Esther Street",
            "address_2": "Hazelden Springbrook Mental Health",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971329529",
            "country_code": "US",
            "telephone_number": "503-538-1174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWAN",
        "first_name": "LANE",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-05",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neil J Desouza, M.D.
• Patricia Lynn Desrochers, LCSW
• Nancy Devine, MS, CCC-SLP
• Pamela A. Devisser, FNP
• Alexandra Rose Devivo
• Vanessa Brizuela Dewees
• David Anthony Dewitt
• Sarah Jeanne Dexheimer
• Karan R Dharia
• Adama Diarra, D.O.

• Clinical Psychologist in Tigard, OR
• Providers in Tigard, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.