Healthcare Provider Details

I. General information

NPI: 1720456825
Provider Name (Legal Business Name): OLIVIA ORDAZ-ROGERS LCSW, CADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST STE 412
EUGENE OR
97401-2688
US

IV. Provider business mailing address

541 WILLAMETTE ST STE 412
EUGENE OR
97401-2688
US

V. Phone/Fax

Practice location:
  • Phone: 541-515-6942
  • Fax:
Mailing address:
  • Phone: 541-515-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-18-248
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10343
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500704899
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier500743988
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: