Provider Demographics
NPI:1477860377
Name:O'GUIN, JON
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:O'GUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E 7TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2676
Mailing Address - Country:US
Mailing Address - Phone:541-296-5452
Mailing Address - Fax:541-296-9418
Practice Address - Street 1:1610 WOODS CT
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2911
Practice Address - Country:US
Practice Address - Phone:541-386-2620
Practice Address - Fax:541-386-6075
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator