Healthcare Provider Details

I. General information

NPI: 1235327545
Provider Name (Legal Business Name): KIMBERLY WARNER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST PSS-460
EUGENE OR
97401-8122
US

IV. Provider business mailing address

1200 HILYARD ST SUITE 200
EUGENE OR
97401-8122
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-7583
  • Fax: 541-687-6214
Mailing address:
  • Phone: 541-687-8583
  • Fax: 541-687-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: