Provider Demographics
NPI:1407688443
Name:DIAZ-JOHNSON, CAMERON JACQUELINE (MS)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:JACQUELINE
Last Name:DIAZ-JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:JACQUELINE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3104
Practice Address - Country:US
Practice Address - Phone:541-357-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health