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1245791987
RANDALL BLAKE NEIDHART
ROSEBURG, OR
NPI
1245791987
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-03-26
Last Update Date
2021-03-03
Business Address
RANDALL BLAKE NEIDHART CADC
621 W MADRONE ST
ROSEBURG, OR 97470-3090
Phone number: 541-671-6838
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Mailing Address
RANDALL BLAKE NEIDHART CADC
621 W MADRONE ST
ROSEBURG, OR 97470-3090
Phone number: 541-671-6838
Copy
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