Healthcare Provider Details

I. General information

NPI: 1336446871
Provider Name (Legal Business Name): KATHLEEN LYNNETTE ADAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN LYNNETTE ADAMSON

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 5TH ST
BROOKINGS OR
97415-9199
US

IV. Provider business mailing address

615 5TH ST
BROOKINGS OR
97415-9199
US

V. Phone/Fax

Practice location:
  • Phone: 541-813-2535
  • Fax:
Mailing address:
  • Phone: 541-813-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10981153-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: