Healthcare Provider Details

I. General information

NPI: 1780452151
Provider Name (Legal Business Name): REBECCA ANN SPULLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 WILLAMETTE ST STE 202
EUGENE OR
97401-2924
US

IV. Provider business mailing address

PO BOX 62
JUNCTION CITY OR
97448-0062
US

V. Phone/Fax

Practice location:
  • Phone: 260-222-6982
  • Fax:
Mailing address:
  • Phone: 260-348-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL30028
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011543A
License Number StateIN

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: