Individual
MR. JOHN LEE FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
1095 25TH ST SE, SALEM, OR 97301-5049
(503) 399-7400
Mailing address
1240 CHEMEKETA ST NE, SALEM, OR 97301-4145
(503) 399-7400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
06-07-55U
OR
171M00000X
Case Manager/Care Coordinator
Primary
06-07055U
OR
Other
Enumeration date
01/30/2007
Last updated
09/11/2025
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