Healthcare Provider Details

I. General information

NPI: 1750592218
Provider Name (Legal Business Name): MRS. JENNIFER ANN COLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN MENNENGA

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 11TH AVE
EUGENE OR
97401-3246
US

IV. Provider business mailing address

350 E 11TH AVE
EUGENE OR
97401-3246
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-1641
  • Fax:
Mailing address:
  • Phone: 541-683-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) 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: