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1639536691
ERNST UDEY SHADBOLT
ROSEBURG, OR
NPI
1639536691
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 08-03-32)
Enumeration Date
2016-01-21
Last Update Date
2016-01-21
Business Address
-- ERNST UDEY SHADBOLT CADC I
2064 SE DOUGLAS AVE
ROSEBURG, OR 97470-3713
Phone number: 541-673-5119
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Mailing Address
-- ERNST UDEY SHADBOLT CADC I
PO BOX 1121
ROSEBURG, OR 97470-0254
Phone number: 541-673-5119
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