Provider Demographics
NPI:1134968753
Name:LARD, STEPHEN (CHW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LARD
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 NE SAVAGE ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1347
Mailing Address - Country:US
Mailing Address - Phone:541-761-0384
Mailing Address - Fax:
Practice Address - Street 1:1060 NE SAVAGE ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1347
Practice Address - Country:US
Practice Address - Phone:541-761-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110353172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker