Healthcare Provider Details

I. General information

NPI: 1770673717
Provider Name (Legal Business Name): DIANE MELINDA HEDIGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 WILLAMETTE ST SUITE B
EUGENE OR
97405-3241
US

IV. Provider business mailing address

PO BOX 5243
EUGENE OR
97405-0243
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-8960
  • Fax: 541-741-4941
Mailing address:
  • Phone: 541-510-8960
  • Fax: 541-741-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1768
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3095
License Number StateAZ

VII. Legacy identifiers

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

# 1
Identifier885163000
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerREGENCE BLUECROSS BLUESHI
# 2
Identifier240183
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
IdentifierL206701
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerPACIFICSOURCE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: