Provider Demographics
NPI:1467933440
Name:JASON, LAKOTAKA DAWN (CADC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:LAKOTAKA
Middle Name:DAWN
Last Name:JASON
Suffix:
Gender:F
Credentials:CADC CANDIDATE
Other - Prefix:
Other - First Name:LAKOTAKA
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:541-684-4156
Practice Address - Street 1:605 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5022
Practice Address - Country:US
Practice Address - Phone:541-684-4133
Practice Address - Fax:541-302-1717
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)