Healthcare Provider Details

I. General information

NPI: 1992636286
Provider Name (Legal Business Name): JOHN WILLIAM SMIDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 W 11TH AVE
EUGENE OR
97402-5435
US

IV. Provider business mailing address

2672 HARRIS ST
EUGENE OR
97405-4120
US

V. Phone/Fax

Practice location:
  • Phone: 541-249-7730
  • Fax:
Mailing address:
  • Phone: 415-378-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: