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NPI Code Detail

MEDICARE: LISA DUVALL-BAKER

MEDICARE: LISA DUVALL-BAKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor06-11-16OR

General Provider Information

NPI Number : 1154633378
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DUVALL-BAKER
Provider Business Mailing Address
First Line : 2555 MAIN ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-2723
Country : US
Telephone Number : 541-883-2795
Fax Number : 541-883-8194
Provider Business Practice Location Address
First Line : 2555 MAIN ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-2723
Country : US
Telephone Number : 541-883-2795
Fax Number : 541-883-8194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2010
Last Update Date : 07/02/2010

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Directions to “ LISA DUVALL-BAKER ” Practice Location

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