Healthcare Provider Details

I. General information

NPI: 1740939297
Provider Name (Legal Business Name): MATTIE ROSE MCCLASKEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 GARDEN AVE STE 206
EUGENE OR
97403-1934
US

IV. Provider business mailing address

1292 HIGH ST # 155
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-4981
  • Fax:
Mailing address:
  • Phone: 541-255-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8132
License Number StateOR

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: