| Heather Fudge Llc | |
|
438 Charnelton St Ste 101 Eugene OR 97401-2760 | |
| (360) 870-3394 | |
| (541) 543-2525 |
| Full Name | Heather Fudge Llc |
|---|---|
| Speciality | Social Worker |
| Location | 438 Charnelton St Ste 101, Eugene, Oregon |
| Authorized Official Name and Position | Heather Fudge (OWNER, PROVIDER) |
| Authorized Official Contact | 3608703944 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Fudge Llc Po Box 11103 Eugene OR 97440-3303 Ph: (360) 870-3394 | Heather Fudge Llc 438 Charnelton St Ste 101 Eugene OR 97401-2760 Ph: (360) 870-3394 |
| NPI Number | 1205592516 |
|---|---|
| Provider Enumeration Date | 11/10/2021 |
| Last Update Date | 08/23/2023 |
| Certification Date | 08/23/2023 |
| Medicare PECOS PAC ID | 1759772296 |
|---|---|
| Medicare Enrollment ID | O20211217000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205592516 | NPI | - | NPPES |
| 500660658 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather Fudge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841560638 PECOS PAC ID: 7911309612 Enrollment ID: I20210716000846 |
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