Individual
MS. VALERIE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
744 NW 4TH ST, CORVALLIS, OR 97330-6415
(541) 753-9792
(541) 753-9792
Mailing address
744 NW 4TH ST, CORVALLIS, OR 97330-6415
(541) 753-9792
(541) 753-9792
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C1040
OR
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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