Individual
AMY LUCASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 757-5900
Mailing address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/22/2017
Last updated
11/22/2017
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