Provider Demographics
NPI:1588022511
Name:SALAS, JUANITA (CADC1-6/1/2014)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:SALAS
Suffix:
Gender:F
Credentials:CADC1-6/1/2014
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 BENNETT LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2775
Mailing Address - Country:US
Mailing Address - Phone:541-735-5408
Mailing Address - Fax:
Practice Address - Street 1:944 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5106
Practice Address - Country:US
Practice Address - Phone:541-687-2667
Practice Address - Fax:541-284-2139
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-P-07171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator