Provider Demographics
NPI:1841075520
Name:BARTLETT, DEBRA JO (BS, CADCI, CHW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JO
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:BS, CADCI, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3792 S UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-6320
Mailing Address - Country:US
Mailing Address - Phone:541-612-2102
Mailing Address - Fax:
Practice Address - Street 1:3792 S UNDERWOOD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-6320
Practice Address - Country:US
Practice Address - Phone:415-612-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)