Provider Demographics
NPI:1780312181
Name:POLLOCK, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0030
Mailing Address - Country:US
Mailing Address - Phone:541-203-0451
Mailing Address - Fax:
Practice Address - Street 1:1095 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3251
Practice Address - Country:US
Practice Address - Phone:707-845-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL110901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical