Individual
JACOB THOMAS VIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3321 HAROLD DR NE, SALEM, OR 97305-1339
(503) 399-5597
Mailing address
250 CHURCH ST SE STE 202, SALEM, OR 97301-3921
(503) 385-8395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/11/2019
Last updated
01/11/2019
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