Provider Demographics
NPI:1013370816
Name:BUETOW, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BUETOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 GREEN ACRES RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1765
Mailing Address - Country:US
Mailing Address - Phone:541-344-4442
Mailing Address - Fax:
Practice Address - Street 1:1498 E MAIN ST
Practice Address - Street 2:#108
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2204
Practice Address - Country:US
Practice Address - Phone:541-942-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10173265237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist