Individual
JONATHAN L ROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4275 COMMERCIAL ST SE STE 180, SALEM, OR 97302-4087
(806) 850-3363
Mailing address
4275 COMMERCIAL ST SE STE 180, SALEM, OR 97302-4087
(806) 850-3363
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000004071
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000004071
TRADITIONAL HEALTH CARE WORKER
OR
Enumeration date
03/13/2020
Last updated
03/13/2020
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