Individual
KACEY JUSTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 JACKSON ST SE, ALBANY, OR 97322-3244
(541) 967-8545
Mailing address
1100 JACKSON ST SE, ALBANY, OR 97322-3244
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
106914
OR
Other
Enumeration date
11/17/2022
Last updated
11/17/2022
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