Individual
MRS. CRISTY LEA BASS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97333
(541) 451-4919
Mailing address
344 S 12TH ST, LEBANON, OR 97355-1410
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
5295680
OR
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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