Individual
SUSAN RAE MASOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS,CADC1
Contact information
Practice address
740 W AIRWAY RD, LEBANON, OR 97355-1337
(541) 451-5617
Mailing address
740 W AIRWAY RD, LEBANON, OR 97355-1337
(541) 451-5617
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
04-11-19
OR
Other
Enumeration date
02/23/2008
Last updated
02/23/2008
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