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General NPI Number Information
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NPI Number | 1184825499
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Entity Type | Individual
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Provider Name | MRS. CRISTY LEA BASS II
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4455 NE HIGHWAY 20
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City | CORVALLIS
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State | OR
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Zip | 97333
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Country | US
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Telephone | 541-451-4919
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Fax |
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Provider Business Mailing Address
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Address Line | 344 S 12TH ST
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City | LEBANON
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State | OR
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Zip | 97355-1410
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5295680
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License Number State | OR
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