Provider Demographics
NPI:1376987677
Name:OSBORN, SALLI-JO
Entity Type:Individual
Prefix:
First Name:SALLI-JO
Middle Name:
Last Name:OSBORN
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 1:1255 PEARL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3570
Mailing Address - Country:US
Mailing Address - Phone:541-687-6983
Mailing Address - Fax:541-687-2063
Practice Address - Street 1:2110 NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2957
Practice Address - Country:US
Practice Address - Phone:541-888-7186
Practice Address - Fax:541-888-7050
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health