Provider Demographics
NPI:1265078299
Name:WAHLUND, ROXSANNE ALYSSA
Entity type:Individual
Prefix:
First Name:ROXSANNE
Middle Name:ALYSSA
Last Name:WAHLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXSANNE
Other - Middle Name:ALYSSA
Other - Last Name:RARICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709
Mailing Address - Country:US
Mailing Address - Phone:541-389-1848
Mailing Address - Fax:541-550-7956
Practice Address - Street 1:60575 BILLADEAU RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:916-502-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator