Healthcare Provider Details

I. General information

NPI: 1568878940
Provider Name (Legal Business Name): MICHELLE LEE RETTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST STE 315
EUGENE OR
97401-2692
US

IV. Provider business mailing address

541 WILLAMETTE ST STE 315
EUGENE OR
97401-2692
US

V. Phone/Fax

Practice location:
  • Phone: 541-824-4461
  • Fax: 503-400-7452
Mailing address:
  • Phone: 541-824-4461
  • Fax: 503-400-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL7674
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: