Provider Demographics
NPI:1568180552
Name:PADGETT, TESSA LEE (PSS, CRM)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:LEE
Last Name:PADGETT
Suffix:
Gender:F
Credentials:PSS, CRM
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:LEE
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-1416
Mailing Address - Country:US
Mailing Address - Phone:541-992-7477
Mailing Address - Fax:
Practice Address - Street 1:612 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1416
Practice Address - Country:US
Practice Address - Phone:541-992-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)