Provider Demographics
NPI:1124404090
Name:NITTLER, EILEEN (MSW)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:NITTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424
Mailing Address - Country:US
Mailing Address - Phone:541-942-3939
Mailing Address - Fax:
Practice Address - Street 1:1345 BIRCH AVENUE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424
Practice Address - Country:US
Practice Address - Phone:541-942-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM5137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker