Individual
MRS. AUTUMN ELIZABETH GRACE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC-R
Contact information
Practice address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 200-2391
Mailing address
113 WILLAMETTE AVE, MEDFORD, OR 97504-7428
(541) 941-1149
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
247000000X
Health Information Technician
—
—
Other
Enumeration date
02/09/2017
Last updated
01/25/2024
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