1679629356 NPI number — MS. BARI S ISAACSON LPC

Table of content: MS. BARI S ISAACSON LPC (NPI 1679629356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679629356 NPI number — MS. BARI S ISAACSON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAACSON
Provider First Name:
BARI
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679629356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 594
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-0126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-492-7222
Provider Business Mailing Address Fax Number:
541-492-7221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 SE MOSHER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97470-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-492-7222
Provider Business Practice Location Address Fax Number:
541-492-7221
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C0923 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P015 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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