Individual
JEREMIE JAY WHARTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1345 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-3939
(541) 942-9310
Mailing address
1345 BIRCH AVE, COTTAGE GROVE, OR 97424-1416
(541) 942-3939
(541) 942-9310
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019047
—
OR
Enumeration date
09/03/2013
Last updated
09/03/2013
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