Healthcare Provider Details

I. General information

NPI: 1619544244
Provider Name (Legal Business Name): S. KELLY CRANE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W 13TH AVE
EUGENE OR
97402-3955
US

IV. Provider business mailing address

PO BOX 21424
EUGENE OR
97402-0408
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-4327
  • Fax: 542-636-3607
Mailing address:
  • Phone: 541-357-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social 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: SUSAN KELLY CRANE
Title or Position: MANAGER
Credential: LCSW
Phone: 541-357-4327