Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003383407 |
---|---|
Provider Name | Sara Jane Renee Salcido |
First Address | Eugene, OR 97402-5060 |
Second Address | Springfield, OR 97477-3363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 06/01/2020 |