Provider Demographics
NPI:1881328474
Name:VEGA, JENNIFER MARIE (CADC R)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:VEGA
Suffix:
Gender:F
Credentials:CADC R
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:VIOLETTE HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-684-4100
Mailing Address - Fax:
Practice Address - Street 1:605 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5022
Practice Address - Country:US
Practice Address - Phone:541-343-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)