| Ignite, Llc | |
|
438 Charnelton St Ste 102 Eugene OR 97401-2760 | |
| (541) 870-2904 | |
| Not Available |
| Full Name | Ignite, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 438 Charnelton St Ste 102, Eugene, Oregon |
| Authorized Official Name and Position | Jasmine Rose Penter (OWNER/CLINICIAN) |
| Authorized Official Contact | 5418702904 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ignite, Llc 1175 Lodgepole Ct Springfield OR 97477-7635 Ph: (541) 870-2904 | Ignite, Llc 438 Charnelton St Ste 102 Eugene OR 97401-2760 Ph: (541) 870-2904 |
| NPI Number | 1336707843 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 03/04/2020 |
| Certification Date | 03/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336707843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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