Individual
ELIZABETH PANUCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121 IOWA ST, KLAMATH FALLS, OR 97601-1606
(541) 883-1030
Mailing address
121 IOWA ST, KLAMATH FALLS, OR 97601-1606
(541) 883-1030
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/17/2015
Last updated
12/21/2019
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