Healthcare Provider Details

I. General information

NPI: 1124775127
Provider Name (Legal Business Name): JOANNA LAUREL RODGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72A CENTENNIAL LOOP STE 150
EUGENE OR
97401-2447
US

IV. Provider business mailing address

4275 COMMERCIAL ST SE STE 180
SALEM OR
97302-4087
US

V. Phone/Fax

Practice location:
  • Phone: 971-707-1479
  • Fax: 541-349-9226
Mailing address:
  • Phone: 503-363-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health 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:
Title or Position:
Credential:
Phone: