MEDICARE: LEEANNA DANAE BARNES

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
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1164198388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEEANNA DANAE BARNES

Provider Business Mailing Address
First Line	:	2601 COVE AVE
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-3900
Country	:	US
Telephone Number	:	541-910-8800
Fax Number	:	541-963-5272

Provider Business Practice Location Address
First Line	:	2601 COVE AVE
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-3900
Country	:	US
Telephone Number	:	541-910-8800
Fax Number	:	541-963-5272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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Directions to “ LEEANNA DANAE BARNES ” Practice Location

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