Healthcare Provider Details

I. General information

NPI: 1376181982
Provider Name (Legal Business Name): MR. QUENTIN RAUSCHENBUSCH-ROWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 COBURG RD STE 200
EUGENE OR
97401-7489
US

IV. Provider business mailing address

2295 COBURG RD STE 200
EUGENE OR
97401-7489
US

V. Phone/Fax

Practice location:
  • Phone: 541-600-2300
  • Fax:
Mailing address:
  • Phone: 541-600-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-19-370
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR8733
License Number StateOR

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: