Healthcare Provider Details

I. General information

NPI: 1588914048
Provider Name (Legal Business Name): LYNN K VIGIL BS; CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 NW 9TH ST
PRINEVILLE OR
97754-1482
US

IV. Provider business mailing address

1333 NW 9TH ST
PRINEVILLE OR
97754-1482
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-2631
  • Fax: 541-447-2616
Mailing address:
  • Phone: 541-447-2631
  • Fax: 541-447-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12-03-65U
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: