Basic Information
| Provider Information | |||||||||
| NPI: | 1124357538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VUCOVICH | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | KATE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 HILYARD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974018122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416827583 | ||||||||
| FaxNumber: | 5416876214 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 HILYARD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974018122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416827583 | ||||||||
| FaxNumber: | 5416876214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2009 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L4768 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.