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NPI Code Detail

MEDICARE: KYMBERLIE ANN ATWOOD MSW, MA PC-A

MEDICARE: KYMBERLIE ANN ATWOOD MSW, MA PC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1366216053
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYMBERLIE ANN ATWOOD MSW, MA PC-A
Provider Business Mailing Address
First Line : 485 44TH AVE SE
Second Line :
City : SALEM
State : OR
Zip : 97317-5412
Country : US
Telephone Number : 360-319-5908
Fax Number :
Provider Business Practice Location Address
First Line : 355 MILLER ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-4247
Country : US
Telephone Number : 360-319-5908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2023
Last Update Date : 11/13/2023

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