Healthcare Provider Details

I. General information

NPI: 1285177485
Provider Name (Legal Business Name): JON RIGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

IV. Provider business mailing address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-2654
  • Fax:
Mailing address:
  • Phone: 541-923-2654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
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: