Individual
JOHN K LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
700 MARION ST NE, SALEM, OR 97301-3829
(503) 363-3660
Mailing address
1173 S 10TH ST, INDEPENDENCE, OR 97351-1563
(570) 947-4492
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
112409
OR
Other
Enumeration date
05/09/2026
Last updated
05/09/2026
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