Healthcare Provider Details

I. General information

NPI: 1548406028
Provider Name (Legal Business Name): SUSAN L BATTLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NW HAWTHORNE
BEND OR
97701
US

IV. Provider business mailing address

1404 NW HARMON BLVD
BEND OR
97701-2329
US

V. Phone/Fax

Practice location:
  • Phone: 541-602-0262
  • Fax:
Mailing address:
  • Phone: 541-602-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3355
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: