Individual
IAN LEUPOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2020 THOMPSON RD, COOS BAY, OR 97420-2041
(541) 267-3511
Mailing address
1750 NEBRASKA AVE BLDG A, GRANTS PASS, OR 97527-5700
(541) 956-4943
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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