Individual
MR. MATTHEW WAYNE THEELER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC1
Contact information
Practice address
399 YOUNG ST, WOODBURN, OR 97071-4817
(503) 981-5265
(503) 981-8736
Mailing address
665 GREENCREST ST NE, NE, SALEM, OR 97301-4982
(503) 371-0059
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
04-07-46
OR
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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