Most Relevant Information
Provider Data
| NPI Number: | 1003182379 |
| Provider Name: | DESARAE MARGARET LANE |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/30/2012 |
| Last Updated: | 03/30/2012 |
Provider Practice Location
715 SW RAMSEY AVE
GRANTS PASS
OR
975275500
Practice Location Phone/Fax
| Phone: | 5419564943 |
| Fax: |
Provider Mailing Location
715 SW RAMSEY AVE
GRANTS PASS
OR
975275500
Provider Mailing Phone/Fax
| Phone: | 5419564943 |
| Fax: |