Provider Demographics
NPI:1194351817
Name:HOYT, ROXANNA J
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:J
Last Name:HOYT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:J
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0882
Mailing Address - Country:US
Mailing Address - Phone:541-429-8844
Mailing Address - Fax:541-278-6330
Practice Address - Street 1:715 SW DORION AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2070
Practice Address - Country:US
Practice Address - Phone:541-429-8800
Practice Address - Fax:541-429-8822
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-20-188101YA0400X
OR20-CRM-047101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500786908Medicaid