Individual
LOIS JEAN GRUSHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L10918
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500742930
—
OR
Enumeration date
05/02/2018
Last updated
04/22/2022
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