Healthcare Provider Details

I. General information

NPI: 1952416976
Provider Name (Legal Business Name): SUSAN OBRIEN-MALEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NW GARDEN VALLEY BLVD
ROSEBURG OR
97470-6523
US

IV. Provider business mailing address

306 CROWN POINT ST
SUTHERLIN OR
97479-7611
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax: 541-440-1273
Mailing address:
  • Phone: 541-459-4694
  • 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: