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General NPI Number Information
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NPI Number | 1801691936
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Entity Type | Individual
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Provider Name | EVAN MACE
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 333 HIGH ST NE
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City | SALEM
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State | OR
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Zip | 97301-3662
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Country | US
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Telephone | 971-397-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 1985 MARKET ST NE
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City | SALEM
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State | OR
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Zip | 97301-2266
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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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