Healthcare Provider Details

I. General information

NPI: 1801318621
Provider Name (Legal Business Name): UNIVERSITY OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 ALDER STREET UNIVERSITY OF OREGON, HEDCO CLINIC
EUGENE OR
97403-5207
US

IV. Provider business mailing address

1655 ALDER STREET UNIVERSITY OF OREGON, HEDCO CLINIC
EUGENE OR
97403-5207
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-0923
  • Fax: 541-346-6772
Mailing address:
  • Phone: 541-346-0923
  • Fax: 541-346-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE ANN MARTINEZ
Title or Position: COORDINATOR FINANCE AND OPERATIONS
Credential: M.ED.
Phone: 541-346-3576