Healthcare Provider Details

I. General information

NPI: 1487786901
Provider Name (Legal Business Name): MISS LEANNE JANET WOLF-WEBBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 HICKORY AVE
EUGENE OR
97401-5306
US

IV. Provider business mailing address

1624 RILEY LN
EUGENE OR
97402-7554
US

V. Phone/Fax

Practice location:
  • Phone: 541-284-7800
  • Fax:
Mailing address:
  • Phone: 541-344-5492
  • 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: