Individual
MICHAEL SIDRIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
548 SE JACKSON ST, ROSEBURG, OR 97470-4983
(541) 672-2691
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-19-138
OR
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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