Healthcare Provider Details

I. General information

NPI: 1073457602
Provider Name (Legal Business Name): NICOLE J L VERNIER CADC I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 NE 7TH ST
GRANTS PASS OR
97526-3403
US

IV. Provider business mailing address

1885 NE 7TH ST
GRANTS PASS OR
97526-3403
US

V. Phone/Fax

Practice location:
  • Phone: 541-955-3210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: