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General NPI Number Information
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NPI Number | 1023870987
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Entity Type | Individual
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Provider Name | SHERRI LEE LANDRENEAU CADC-R
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 300 W MAIN ST
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City | MEDFORD
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State | OR
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Zip | 97501-2756
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Country | US
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Telephone | 547-772-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 FALCON ST SPC 12A
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City | WHITE CITY
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State | OR
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Zip | 97503-1320
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Country | US
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Telephone | 530-693-8807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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