Individual
KARISSA MODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
440 E BROADWAY STE 100, EUGENE, OR 97401-3338
(541) 712-3011
Mailing address
1390 M ST, SPRINGFIELD, OR 97477-3210
(702) 596-4410
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
A16157
OR
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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