Individual
HEATHER FUDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
438 CHARNELTON ST STE 101, EUGENE, OR 97401-2760
(458) 331-0531
(541) 543-2525
Mailing address
PO BOX 11103, EUGENE, OR 97440-3303
(458) 331-0531
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500660658
—
OR
Enumeration date
01/10/2012
Last updated
08/19/2025
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