Provider Demographics
NPI:1366579575
Name:SLOPER, AMY RUSHELL GROAT (MA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUSHELL GROAT
Last Name:SLOPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0016
Mailing Address - Country:US
Mailing Address - Phone:503-415-1595
Mailing Address - Fax:
Practice Address - Street 1:10 S BARTLETT ST STE 204
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7204
Practice Address - Country:US
Practice Address - Phone:541-631-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2267101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health