Healthcare Provider Details

I. General information

NPI: 1437508801
Provider Name (Legal Business Name): DEBRA DEPEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 A CENTENNIAL LOOP #150
EUGENE OR
97401
US

IV. Provider business mailing address

72A CENTENNIAL LOOP #150
EUGENE OR
97401-2444
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-2876
  • Fax:
Mailing address:
  • Phone: 541-342-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

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: