JESSE C STAUBACH (NPI# 1114560802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114560802 |
| Entity Type | Individual |
| Full Name | JESSE C STAUBACH |
| Practice Address |
320 Central Ave Ste 304 Coos Bay OR 97420-2241 |
| Mailing Address |
Po Box 802 Coos Bay OR 97420-0148 |
| Practice Telephone | 5413667640 |
| Mailing Telephone | 5412959240 |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2019-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | THW000003807 | OR | Other Service Providers |
| Street Address |
320 CENTRAL AVE STE 304 |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-2241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609097948 | Deborah B Manders | Acupuncturist | 320 Central Ave Ste 304, Coos Bay, OR 97420-2241 | 2007-05-02 |
| 1184225435 | Christine Joy Dupres | Social Worker | 320 Central Ave Ste 304, Coos Bay, OR 97420-2241 | 2020-11-03 |
| 1073146353 | All Tribes Free Mental Health Care Services | Social Worker | 320 Central Ave Ste 304, Coos Bay, OR 97420-2241 | 2020-02-14 |
| 1447747001 | Leslie Jo Lintner | Counselor | 320 Central Ave Ste 304, Coos Bay, OR 97420-2241 | 2018-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215550934 | Tabetha Lynn Evernden | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2020-05-28 |
| 1154944346 | Andrea Gross | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2020-05-21 |
| 1013536986 | William Todd Stone | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2020-04-10 |
| 1003445875 | Sarah Susan Tucker | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2020-04-03 |
| 1881229797 | Kelli Woods | Peer Specialist | 2020 Thompson Rd, Coos Bay, OR 97420-2041 | 2020-03-11 |
| 1477188399 | Dorannlyn Mills | Peer Specialist | 2020 Thompson Rd, Coos Bay, OR 97420-2041 | 2020-03-11 |
| 1376174003 | Joshua Jay Haynes | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2020-01-31 |
| 1730743535 | Paul Gonzales | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2019-04-26 |
| 1396201216 | Anthony L Wilson | Peer Specialist | 155 S Empire Blvd, Coos Bay, OR 97420-3374 | 2019-02-15 |
| 1225593668 | Riley Kirby | Peer Specialist | 2020 Thompson Rd, Coos Bay, OR 97420-2041 | 2019-02-08 |
| Find all providers in COOS BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.