Healthcare Provider Details

I. General information

NPI: 1063585065
Provider Name (Legal Business Name): JACKSON CO CHILD ABUSE TASK FORCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 W 10TH ST
MEDFORD OR
97501-3016
US

IV. Provider business mailing address

816 W 10TH ST
MEDFORD OR
97501-3016
US

V. Phone/Fax

Practice location:
  • Phone: 541-734-5437
  • Fax: 541-734-2425
Mailing address:
  • Phone: 541-734-5437
  • Fax: 541-734-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMI PITZEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-734-5437