Provider Demographics
NPI:1972096139
Name:QUAMME, ROBERT (BS, CADC I)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:QUAMME
Suffix:
Gender:M
Credentials:BS, CADC I
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 1288
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0368
Mailing Address - Country:US
Mailing Address - Phone:541-464-6536
Mailing Address - Fax:
Practice Address - Street 1:337 SE FOWLER ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4348
Practice Address - Country:US
Practice Address - Phone:541-464-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-17-340101YA0400X
OR1366697690101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)