MEDICARE: DOMINIQUE RACHEL CARLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	THW112506	OR
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1235945882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE RACHEL CARLSON

Provider Business Mailing Address
First Line	:	3587 HEATHROW WAY
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-4004
Country	:	US
Telephone Number	:	541-858-8170
Fax Number	:	541-858-8167

Provider Business Practice Location Address
First Line	:	2525 PORTLAND ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-3153
Country	:	US
Telephone Number	:	541-515-6321
Fax Number	:	541-515-6195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	01/17/2025

Similar Medicare Providers

1114377637 — COLUMBIACARE SERVICES
Practice Location Address:

2525 PORTLAND ST
EUGENE, OR
97405-3153

Practice Phone: 541-858-8170
Practice Fax: 541-858-8167

1649821356 — BELINDA A SMITH
Practice Location Address:

2525 PORTLAND ST
EUGENE, OR
97405-3153

Practice Phone: 541-515-6321
Practice Fax: 541-515-6195

1538864038 — ROBERT JACKSON
Practice Location Address:

2525 PORTLAND ST
EUGENE, OR
97405-3153

Practice Phone: 541-515-6321
Practice Fax: 541-515-6195

1235844127 — AUDREY KOCH SWEETERMAN CD, P.S.S.
Practice Location Address:

2975 PEARL ST
EUGENE, OR
97405-3715

Practice Phone: 614-256-2667
Practice Fax:

1457837809 — AMY ELIZABETH MAY LCSW
Practice Location Address:

3575 DONALD ST STE 250
EUGENE, OR
97405-4783

Practice Phone: 458-215-1170
Practice Fax:

1831045848 — KARTA PURKH SINGH KHALSA CD-N
Practice Location Address:

4627 FOX HOLLOW RD
EUGENE, OR
97405-5301

Practice Phone: 541-242-3314
Practice Fax: 541-242-3314

Directions to “ DOMINIQUE RACHEL CARLSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.