Provider Demographics
NPI:1508351172
Name:LAZAR, SHANDRA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANDRA
Middle Name:RAE
Last Name:LAZAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 ALYSSA CIR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-7715
Mailing Address - Country:US
Mailing Address - Phone:307-315-5318
Mailing Address - Fax:
Practice Address - Street 1:503 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4159
Practice Address - Country:US
Practice Address - Phone:307-315-5318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health