Provider Demographics
NPI:1124485925
Name:POPE-SCHAEDLER, MARY PATRICIA (CADC I)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:POPE-SCHAEDLER
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:PATTIE
Other - Middle Name:
Other - Last Name:SCHAEDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-673-5119
Mailing Address - Fax:541-957-3734
Practice Address - Street 1:2064 SE DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3713
Practice Address - Country:US
Practice Address - Phone:541-673-5119
Practice Address - Fax:541-957-3734
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-09-44101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)