Basic Information
| Provider Information | |||||||||
| NPI: | 1487781340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASKO | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1472 5TH CT | ||||||||
| Address2: | |||||||||
| City: | STAYTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973831364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039999374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 MARKET ST NE STE 530 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973011835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033905637 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.