Healthcare Provider Details

I. General information

NPI: 1295466829
Provider Name (Legal Business Name): KATHRYN MARIE DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N PLATT AVE
EAGLE POINT OR
97524-8618
US

IV. Provider business mailing address

1000 E MAIN ST
MEDFORD OR
97504-7449
US

V. Phone/Fax

Practice location:
  • Phone: 541-830-6617
  • Fax: 541-414-1925
Mailing address:
  • Phone: 541-773-3863
  • Fax: 541-500-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9455
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: