Provider Demographics
NPI:1154529600
Name:LAVALLEE CONNIFF, LINDA S (MSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:LAVALLEE CONNIFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:216 SW MADISON AV
Mailing Address - Street 2:#9 10
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333
Mailing Address - Country:US
Mailing Address - Phone:541-752-4803
Mailing Address - Fax:541-752-3360
Practice Address - Street 1:216 SW MADISON AV
Practice Address - Street 2:#9 10
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333
Practice Address - Country:US
Practice Address - Phone:541-752-4803
Practice Address - Fax:541-752-3360
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical