| Doctor Name: | MARK DETWEILER |
| NPI Number: | 1801024187 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., CCC-SLP |
| License Number: | 13103 |
| Business Practice Address: | 1500 W 12th Ave Eugene, OR - 974023705 |
| Business Phone Number: | 5412844880 |
| Business Fax Number: | 5414856159 |
| Mailing Address: | 1500 W 12th Ave, EUGENE |
| State: | OR |
| Postal Code: | 974023705 |
| Phone Number: | 5412844880 |
| Fax Number: | 5414856159 |
| NPI Enumeration Date: | 06/25/2009 |
| NPI Last Update Date: | 06/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 13103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |