Healthcare Provider Details

I. General information

NPI: 1154232577
Provider Name (Legal Business Name): ELIZABETH HELEN PRATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SW SHEVLIN HIXON DR
BEND OR
97702-3209
US

IV. Provider business mailing address

319 NW FIR AVE
REDMOND OR
97756-1546
US

V. Phone/Fax

Practice location:
  • Phone: 541-610-8391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA18634
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: