Healthcare Provider Details

I. General information

NPI: 1497378616
Provider Name (Legal Business Name): AARON EARLYWINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 COUNTRY CLUB RD STE 222
EUGENE OR
97401-2238
US

IV. Provider business mailing address

921 COUNTRY CLUB RD STE 222
EUGENE OR
97401-2238
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-6000
  • Fax:
Mailing address:
  • Phone: 541-686-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2103771
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC7584
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: