Healthcare Provider Details

I. General information

NPI: 1659096840
Provider Name (Legal Business Name): AMBER LYNN FAUTEAUX MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 RIVER RD
EUGENE OR
97404-3212
US

IV. Provider business mailing address

1820 FERRY ST APT 118
EUGENE OR
97401-5483
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-2611
  • Fax:
Mailing address:
  • Phone: 541-359-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: