MEDICARE: KATHERINE J KENT MSW, LCSW

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
1	1041C0700X	Clinical Social Worker	5376	OR

General Provider Information

NPI Number	:	1821113572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE J KENT MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1273
Second Line	:
City	:	MERLIN
State	:	OR
Zip	:	97532-1273
Country	:	US
Telephone Number	:	541-474-3975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 NE 7TH ST
Second Line	:	SUITE C
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1451
Country	:	US
Telephone Number	:	541-474-3975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/18/2012

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