Basic Information
| Provider Information | |||||||||
| NPI: | 1417496316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON-RHOADS | ||||||||
| FirstName: | DEIRDRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 BIRCH AVE | ||||||||
| Address2: | |||||||||
| City: | COTTAGE GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974241413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419423939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47815 HIGHWAY 58 | ||||||||
| Address2: | |||||||||
| City: | OAKRIDGE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974639572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417828304 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2017 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 500720823 | 05 | OR | MEDICAID |