1912552233 NPI number — DR. JESSICA GIBSON FLEMING LINSCOTT PH.D.

Table of content: DR. JESSICA GIBSON FLEMING LINSCOTT PH.D. (NPI 1912552233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912552233 NPI number — DR. JESSICA GIBSON FLEMING LINSCOTT PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINSCOTT
Provider First Name:
JESSICA
Provider Middle Name:
GIBSON FLEMING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912552233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 CLUB RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-2439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-393-5983
Provider Business Mailing Address Fax Number:
541-393-5984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-393-5983
Provider Business Practice Location Address Fax Number:
541-393-5984
Provider Enumeration Date:
08/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  3124 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500766701 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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