Healthcare Provider Details

I. General information

NPI: 1780142273
Provider Name (Legal Business Name): ELYSSA VICTORIA CALDERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 RIVER RD N
SALEM OR
97303-6512
US

IV. Provider business mailing address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax:
Mailing address:
  • Phone: 541-321-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR11522
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: