Provider Demographics
NPI:1821704370
Name:COLLOM, JO ANNE (CRM)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
Last Name:COLLOM
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84617 SARVIS BERRY LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9452
Mailing Address - Country:US
Mailing Address - Phone:541-301-4361
Mailing Address - Fax:
Practice Address - Street 1:315 COBURG RD STE C
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6114
Practice Address - Country:US
Practice Address - Phone:541-525-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-CRM-1320175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist