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1164996278
JACOB THOMAS VIDA
SALEM, OR
NPI
1164996278
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-01-11
Last Update Date
2019-01-11
Business Address
JACOB THOMAS VIDA
3321 HAROLD DR NE
SALEM, OR 97305-1339
Phone number: 503-399-5597
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Mailing Address
JACOB THOMAS VIDA
250 CHURCH ST SE STE 202
SALEM, OR 97301-3921
Phone number: 503-385-8395
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