Healthcare Provider Details

I. General information

NPI: 1780904201
Provider Name (Legal Business Name): JESSICA SUSAN CLAYPOOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 W 7TH AVE
EUGENE OR
97402-4611
US

IV. Provider business mailing address

941 W 7TH AVE
EUGENE OR
97402-4611
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-4310
  • Fax: 541-868-1596
Mailing address:
  • Phone: 541-686-4310
  • Fax: 541-868-1596

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: