Healthcare Provider Details

I. General information

NPI: 1528675964
Provider Name (Legal Business Name): SAMANTHA UEHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

IV. Provider business mailing address

1355 OAK ST STE 100
EUGENE OR
97401-3566
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-3826
  • Fax:
Mailing address:
  • Phone: 541-632-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7660
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1020987
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: