=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841075520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA JO BARTLETT BS, CADCI, CHW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2023
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3792 S UNDERWOOD RD
-----------------------------------------------------
City | SCOTTSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47170-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-612-2102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3792 S UNDERWOOD RD
-----------------------------------------------------
City | SCOTTSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47170-6320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-612-2102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------