Healthcare Provider Details

I. General information

NPI: 1922474220
Provider Name (Legal Business Name): CANDICE MOTTWEILER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 HILYARD ST
EUGENE OR
97405-3684
US

IV. Provider business mailing address

255 RIVER AVE UNIT 40152
EUGENE OR
97404-0803
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-7828
  • Fax:
Mailing address:
  • Phone: 541-246-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3049
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: