Provider Demographics
NPI:1497954028
Name:PARKER, CHERYL LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEIGH
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LEIGH
Other - Last Name:KRKOC--PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1340 NW WALL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1985
Mailing Address - Country:US
Mailing Address - Phone:541-385-1747
Mailing Address - Fax:541-388-6617
Practice Address - Street 1:1340 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1985
Practice Address - Country:US
Practice Address - Phone:541-385-1747
Practice Address - Fax:541-388-6617
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2940101YM0800X
OR24901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health