Healthcare Provider Details

I. General information

NPI: 1245286194
Provider Name (Legal Business Name): JAY M LAWSHE CADCII, NCACII
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LANCASTER DR NE
SALEM OR
97301-5110
US

IV. Provider business mailing address

115 LANCASTER DR NE
SALEM OR
97301-5110
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-9762
  • Fax: 503-315-2019
Mailing address:
  • Phone: 503-391-9762
  • Fax: 503-315-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9610131
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: