Basic Information
| Provider Information | |||||||||
| NPI: | 1851980981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEZUK | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | JOLEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 E 48TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974053512 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3377 RIVERBEND DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974778803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412226160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2021 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 13497 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.