Basic Information
Provider Information
NPI: 1003140021
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEPPER-REED
FirstName: SUSAN
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: B.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1258 HIGH ST
Address2:  
City: EUGENE
State: OR
PostalCode: 974013238
CountryCode: US
TelephoneNumber: 5413428437
FaxNumber: 5412422999
Practice Location
Address1: 1258 HIGH ST
Address2:  
City: EUGENE
State: OR
PostalCode: 974013238
CountryCode: US
TelephoneNumber: 5413428437
FaxNumber: 5412422999
Other Information
ProviderEnumerationDate: 09/23/2009
LastUpdateDate: 05/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health
175T00000X  Y    

No ID Information.


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