Healthcare Provider Details

I. General information

NPI: 1609531243
Provider Name (Legal Business Name): CADEN DELOACH BS PUBLIC HEALTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NW 27TH ST
CORVALLIS OR
97330-5223
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-6835
  • Fax: 541-766-6186
Mailing address:
  • Phone: 541-766-6835
  • Fax: 541-766-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number24-QMHA-I-004413
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: