Dejack, Tova

Dejack, Tova is an individual health care provider with primary practice located at 19 Myrtle St , Medford OR 97504-7337. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Dejack, Tova can be contacted via phone (541) 324-4617.

Contact Information

Primary practice address
19 Myrtle St Medford OR 97504-7337
Phone: (541) 324-4617
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1578736757
LBN Legal business name Dejack, Tova
Credentials MSW, LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 8th, 2008
Last updated Sep 19th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578736757 NPPES
Oregon MEDICAID 227698

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