Provider Demographics
NPI:1023463452
Name:WETMORE, VALINDA SUE (LCSW)
Entity type:Individual
Prefix:
First Name:VALINDA
Middle Name:SUE
Last Name:WETMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 WILLAMETTE ST # 10
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3241
Mailing Address - Country:US
Mailing Address - Phone:541-972-3722
Mailing Address - Fax:541-632-8270
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-972-3722
Practice Address - Fax:541-632-8270
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL69491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500705302Medicaid