Individual
LEONA IKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
850 SW 4TH ST, MADRAS, OR 97741-9628
(541) 475-6575
(541) 504-1195
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 516-4087
(841) 504-1195
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-CRM-044
OR
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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