Healthcare Provider Details

I. General information

NPI: 1346173416
Provider Name (Legal Business Name): MS. EDEN KEATS HEINZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 RIVER RD
EUGENE OR
97404-3212
US

IV. Provider business mailing address

3495 VAN BUREN ST
EUGENE OR
97405-2332
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-5462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: