Provider Demographics
NPI:1376745448
Name:LAKE, CLAUDIA KATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:KATHERINE
Last Name:LAKE
Suffix:
Gender:F
Credentials:PSYD
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 1665
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-1665
Mailing Address - Country:US
Mailing Address - Phone:541-761-6764
Mailing Address - Fax:541-592-6479
Practice Address - Street 1:228 NW B ST
Practice Address - Street 2:UPPER UNIT
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2032
Practice Address - Country:US
Practice Address - Phone:541-761-6764
Practice Address - Fax:541-592-6479
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16678103TC0700X
OR2322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376345448OtherNPI