Healthcare Provider Details

I. General information

NPI: 1609825900
Provider Name (Legal Business Name): WILLIAM BATEMAN COLLINGE MSW, PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 KINCAID ST
EUGENE OR
97405-4312
US

IV. Provider business mailing address

3480 KINCAID ST
EUGENE OR
97405-4312
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-3502
  • Fax: 207-510-8060
Mailing address:
  • Phone: 541-632-3502
  • Fax: 207-510-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC8315
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5252
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: