Individual
ERNST UDEY SHADBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
2064 SE DOUGLAS AVE, ROSEBURG, OR 97470-3713
(541) 673-5119
(541) 957-3734
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 673-5119
(541) 957-3734
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08-03-32
OR
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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