Healthcare Provider Details

I. General information

NPI: 1457722050
Provider Name (Legal Business Name): SAMANTHA KEISER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 HIGH ST # 1094
EUGENE OR
97401-3238
US

IV. Provider business mailing address

1292 HIGH ST # 1094
EUGENE OR
97401-3238
US

V. Phone/Fax

Practice location:
  • Phone: 541-725-2710
  • Fax:
Mailing address:
  • Phone: 541-725-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL17495
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: