Healthcare Provider Details

I. General information

NPI: 1356184170
Provider Name (Legal Business Name): ANNA DIANE BARTUSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 UNIVERSITY ST
EUGENE OR
97403
US

IV. Provider business mailing address

1804 COLUMBIA ST
EUGENE OR
97403-1438
US

V. Phone/Fax

Practice location:
  • Phone: 541-525-0196
  • Fax:
Mailing address:
  • Phone: 949-345-5964
  • 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: