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General NPI Number Information
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NPI Number | 1407684392
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Entity Type | Organization
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Legal Business Name | LANE COUNTY OREGON
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2073 OLYMPIC ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3413
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Country | US
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Telephone | 541-682-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 151 W 7TH AVE STE 210
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City | EUGENE
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State | OR
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Zip | 97401-2676
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MICHELLE LYNN PETERSON
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Credential |
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Telephone | 541-682-7987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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