Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | OR |
NPI | 1003316126 |
---|---|
Provider Name | Cassie Glerup |
First Address | Baker City, OR 97814-2615 |
Second Address | Baker City, OR 97814-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 15/02/2018 |