Provider Demographics
NPI:1518546373
Name:MARCUS, SAMUEL (BILINGUAL PSS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MARCUS
Suffix:
Gender:M
Credentials:BILINGUAL PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1664
Mailing Address - Country:US
Mailing Address - Phone:458-224-2377
Mailing Address - Fax:
Practice Address - Street 1:1195A CITY VIEW ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3325
Practice Address - Country:US
Practice Address - Phone:458-224-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist