Healthcare Provider Details

I. General information

NPI: 1023463452
Provider Name (Legal Business Name): VALINDA SUE WETMORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 WILLAMETTE ST
EUGENE OR
97405-3241
US

IV. Provider business mailing address

3003 WILLAMETTE ST # 10
EUGENE OR
97405-3241
US

V. Phone/Fax

Practice location:
  • Phone: 541-972-3722
  • Fax: 541-632-8270
Mailing address:
  • Phone: 541-972-3722
  • Fax: 541-632-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6949
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500705302
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: