Provider Information for 1700352127
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MITCHELL RYAN MCDONALD CSWA
Sex: Male
NPI: 1700352127
Last Updated: 2020-04-13
Certification Date: 2020-04-13
Certification Date: 2020-04-13
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1700352127 | ||||||||||||
| Enumeration Date | 2018-10-23 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1790 W 11TH AVE STE 200 EUGENE, OR 97402-3871 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 260 E 11TH AVE EUGENE, OR 97401-3247 United States Phone: 541-484-4428 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 71 CENTENNIAL LOOP | ||||||||||||
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