Healthcare Provider Details

I. General information

NPI: 1376989418
Provider Name (Legal Business Name): STEVEN BALDONI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N MERIDIAN ST
NEWBERG OR
97132-2814
US

IV. Provider business mailing address

PO BOX 1579
MCMINNVILLE OR
97128-1579
US

V. Phone/Fax

Practice location:
  • Phone: 503-474-2024
  • 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 StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: