Larisa Ivana Czernowski

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

T-22-1577 Issued in OR

Practice address

2575 NW Kline St
Roseburg, OR 97471-8827

Phone

(541) 673-3504

NPI assigned

Apr 28, 2022

Last updated

Apr 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1215672837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 SE MAIN ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974704213",
            "telephone_number": "541-670-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 NW KLINE ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718827",
            "telephone_number": "541-673-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZERNOWSKI",
        "first_name": "LARISA",
        "middle_name": "IVANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "T-22-1577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amie C Culley
• Janice Lee Cummins, CADC I
• Jeanie Michelle Curphey
• Mary Ann Curtiss, ANP-BC
• Philip Michael Cusack, OTR/L
• Phillip R Dahl, L.D
• Tyson Jarad Dahl, PA-C
• Gary B. Dandy, MD
• Daniel J. Olson DDS PHD PC
• Carol Lynn Daniels, RN

• Addiction (Substance Use Disorder) Counselor in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.