Provider Demographics
NPI:1235298696
Name:KOEPPEL, JEFF P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:P
Last Name:KOEPPEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-1307
Mailing Address - Country:US
Mailing Address - Phone:541-942-2850
Mailing Address - Fax:541-942-1574
Practice Address - Street 1:410 N 9TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1307
Practice Address - Country:US
Practice Address - Phone:541-942-2850
Practice Address - Fax:541-942-1574
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL39081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR019047Medicaid