Healthcare Provider Details

I. General information

NPI: 1447494018
Provider Name (Legal Business Name): NANETTE CARROLL JOERS CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 W 11TH AVE SUITE 290
EUGENE OR
97402-3758
US

IV. Provider business mailing address

78161 HIGH PRAIRIE RD
OAKRIDGE OR
97463-4501
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax:
Mailing address:
  • Phone: 541-782-2748
  • 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:

# 1
Identifier04-R-16
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerCERTIFIED ALCOHOL AND DRUG COUNSELOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: