Healthcare Provider Details

I. General information

NPI: 1497009393
Provider Name (Legal Business Name): KATHLEEN JOYE DANIEL MA CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

IV. Provider business mailing address

687 CHESHIRE AVE
EUGENE OR
97402-5060
US

V. Phone/Fax

Practice location:
  • Phone: 541-762-4313
  • Fax: 541-762-0739
Mailing address:
  • Phone: 541-762-4314
  • Fax: 541-762-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number96-04-81
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: