Healthcare Provider Details

I. General information

NPI: 1285038695
Provider Name (Legal Business Name): JEREMY ANDRESEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 OLIVE ST STE 307
EUGENE OR
97401-2995
US

IV. Provider business mailing address

1144 GATEWAY LOOP STE 200
SPRINGFIELD OR
97477-7706
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-5060
  • Fax:
Mailing address:
  • Phone: 541-686-5060
  • 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: