Provider Demographics
NPI:1396019105
Name:SCHAEFER-LIMBACH, JORDAN LEONARD (BA, QMHA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:LEONARD
Last Name:SCHAEFER-LIMBACH
Suffix:
Gender:M
Credentials:BA, QMHA
Other - Prefix:MR
Other - First Name:JORDAN
Other - Middle Name:LEONARD
Other - Last Name:LIMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, QMHA
Mailing Address - Street 1:10 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4928
Mailing Address - Country:US
Mailing Address - Phone:541-485-2711
Mailing Address - Fax:815-572-5513
Practice Address - Street 1:10 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4928
Practice Address - Country:US
Practice Address - Phone:541-485-2711
Practice Address - Fax:815-572-5513
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500724783Medicaid
OR500663312Medicaid