Most Relevant Information
Provider Data
| NPI Number: | 1003322553 |
| Provider Name: | SHOSHANNA NOELLE LANE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/20/2017 |
| Last Updated: | 10/04/2023 |
Provider Practice Location
300 W MAIN ST
MEDFORD
OR
975012756
Practice Location Phone/Fax
| Phone: | 5417721777 |
| Fax: |
Provider Mailing Location
300 W MAIN ST
MEDFORD
OR
975012756
Provider Mailing Phone/Fax
| Phone: | 5417721777 |
| Fax: |