Individual
JEREMY WADE KLOOTWYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1011 COMMERCIAL ST NE, SALEM, OR 97301-1049
(503) 983-9900
Mailing address
1011 COMMERCIAL ST NE, SALEM, OR 97301-1049
(503) 983-9900
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-CRM-1999
OR
Other
Enumeration date
05/26/2023
Last updated
05/26/2023
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