Healthcare Provider Details

I. General information

NPI: 1558094656
Provider Name (Legal Business Name): LACIE BAUMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LACIE LOWTHER

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 NW 3RD AVE
CANBY OR
97013-3503
US

IV. Provider business mailing address

4841 BREITENBUSH AVE NE
SALEM OR
97301-5220
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-3840
  • Fax: 503-575-3707
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9301
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: