# OREGON EMDR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699286591
- **Authorized official:** SUSAN MARIE WENDELBORG LCSW (OWNER)
- **Authorized official phone:** (541) 525-9416

## Contact information

- **Practice address:** 175 W B ST, SPRINGFIELD, OR 97477-4575
- **Practice address phone:** (541) 525-9416
- **Practice address fax:** (541) 722-7033
- **Mailing address:** 1863 PIONEER PKWY E, SPRINGFIELD, OR 97477-3907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | L5896 | OR | Yes |

## Other

- **Enumeration date:** 10/18/2017
- **Last updated:** 10/18/2017