Healthcare Provider Details

I. General information

NPI: 1427591502
Provider Name (Legal Business Name): ALISHA LUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST STE 301
ASTORIA OR
97103-3364
US

IV. Provider business mailing address

65 N HIGHWAY 101 STE 204
WARRENTON OR
97146-9371
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-0241
  • Fax: 503-861-2043
Mailing address:
  • Phone: 503-325-0241
  • Fax: 503-861-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: