Individual
MR. JACK BLANTON WILLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., P.A.
Contact information
Practice address
1414 KINCAID ST, EUGENE, OR 97401-3737
(541) 505-2080
Mailing address
1414 KINCAID ST, EUGENE, OR 97401-3737
(541) 505-2080
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5052
OR
Other
Enumeration date
11/11/2008
Last updated
11/11/2008
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