Healthcare Provider Details

I. General information

NPI: 1730274010
Provider Name (Legal Business Name): JEFF R. COLE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 NE STEPHENS STREET SUITE A
ROSEBURG OR
97470-3166
US

IV. Provider business mailing address

693 NE STEPHENS ST STE A
ROSEBURG OR
97470-3166
US

V. Phone/Fax

Practice location:
  • Phone: 541-643-1375
  • Fax: 541-464-8700
Mailing address:
  • Phone: 541-643-1375
  • Fax: 541-464-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1332
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: