Healthcare Provider Details

I. General information

NPI: 1457953564
Provider Name (Legal Business Name): PAUL DAVID MALECKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

IV. Provider business mailing address

4257 BARGER DR SPC 273
EUGENE OR
97402-1310
US

V. Phone/Fax

Practice location:
  • Phone: 541-684-4100
  • Fax: 541-684-4156
Mailing address:
  • Phone: 713-504-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
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: