Healthcare Provider Details

I. General information

NPI: 1790325967
Provider Name (Legal Business Name): ERIN ZURBRUGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SW 45TH PL
CORVALLIS OR
97333-1768
US

IV. Provider business mailing address

1650 SW 45TH PL
CORVALLIS OR
97333-1768
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-8068
  • Fax:
Mailing address:
  • Phone: 541-757-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: