Individual
MR. CORY JON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, MPA
Contact information
Practice address
211 E 7TH AVE, EUGENE, OR 97401-2773
(541) 242-0460
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 242-0460
(541) 465-6602
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
7238604-3502
UT
1041C0700X
Clinical Social Worker
Primary
7238604-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7238604-3501
STATE OF UTAH - DEPARTMENT OF COMMERCE
UT
01
—
7238604-3502
STATE OF UTAH DEPARTMENT OF PROFESSIONAL LICENSING
UT
Enumeration date
11/16/2009
Last updated
02/10/2012
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