Provider Demographics
NPI:1578201679
Name:TRAVER, JONI B (CRM)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:B
Last Name:TRAVER
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:
Other - Last Name:TRAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1003 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7140
Mailing Address - Country:US
Mailing Address - Phone:541-779-1282
Mailing Address - Fax:541-608-2888
Practice Address - Street 1:16 S PEACH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2945
Practice Address - Country:US
Practice Address - Phone:541-779-1282
Practice Address - Fax:541-608-2888
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist