Provider Demographics
NPI:1770673717
Name:HEDIGER, DIANE MELINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MELINDA
Last Name:HEDIGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5243
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0243
Mailing Address - Country:US
Mailing Address - Phone:541-510-8960
Mailing Address - Fax:541-741-4941
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-510-8960
Practice Address - Fax:541-741-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1768103TC0700X
AZ3095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR885163000OtherREGENCE BLUECROSS BLUESHI
OR240183Medicaid
ORL206701OtherPACIFICSOURCE
OR135858Medicare ID - Type UnspecifiedMANDATORY PARTICIPATING