Healthcare Provider Details

I. General information

NPI: 1124365853
Provider Name (Legal Business Name): AMY ROSE WOOTTON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

IV. Provider business mailing address

1075 WASHINGTON ST STE 201
EUGENE OR
97401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 541-908-5495
  • Fax:
Mailing address:
  • Phone: 541-908-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health 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: