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NPI Code Detail

MEDICARE: MS. LEZLIE NEUSTETER KELLISON LCSW

MEDICARE: MS. LEZLIE NEUSTETER KELLISON LCSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1497937692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEZLIE NEUSTETER KELLISON LCSW
Provider Business Mailing Address
First Line : P.O. BOX 1716
Second Line :
City : SISTERS
State : OR
Zip : 97759
Country : US
Telephone Number : 562-618-5391
Fax Number : 619-400-5159
Provider Business Practice Location Address
First Line : 389 SW SCALEHOUSE CT
Second Line :
City : BEND
State : OR
Zip : 97702-3241
Country : US
Telephone Number : 626-185-3915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2007
Last Update Date : 06/23/2024

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