1952734592 NPI number — BETTYANN JANE SINGH MSW

Table of content: BETTYANN JANE SINGH MSW (NPI 1952734592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952734592 NPI number — BETTYANN JANE SINGH MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGH
Provider First Name:
BETTYANN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAFER
Provider Other First Name:
BETTYANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952734592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2073 OLYMPIC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97477-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-682-3550
Provider Business Mailing Address Fax Number:
541-682-3551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 MARTIN LUTHER KING JR BLVD
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:
97401-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-682-3608
Provider Business Practice Location Address Fax Number:
541-682-3276
Provider Enumeration Date:
08/19/2013

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: 104100000X , 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: 500663419 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".