Provider Demographics
NPI:1831527886
Name:WASMUND, MARY LYNN
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:WASMUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:LUCIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:724 S. CENTRAL, SUITE 101
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-776-5793
Mailing Address - Fax:541-776-5798
Practice Address - Street 1:724 S. CENTRAL, SUITE 101
Practice Address - Street 2:FAMILY SOLUTIONS
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-776-5793
Practice Address - Fax:541-776-5798
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst