Healthcare Provider Details

I. General information

NPI: 1851208458
Provider Name (Legal Business Name): JACOB DANIEL RENAGHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STATE HWY 99 N
EUGENE OR
97402
US

IV. Provider business mailing address

955 CHAMBERS ST
EUGENE OR
97402-4328
US

V. Phone/Fax

Practice location:
  • Phone: 541-461-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: