Healthcare Provider Details

I. General information

NPI: 1477702918
Provider Name (Legal Business Name): KIMBERLY WHITNEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY MCDOWELL

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 160
EUGENE OR
97401-2439
US

IV. Provider business mailing address

PO BOX 70779
SPRINGFIELD OR
97475-0137
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-1722
  • Fax: 541-485-7049
Mailing address:
  • Phone: 541-345-1722
  • Fax: 541-485-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1815
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1815
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier14372849
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH ID
# 2
Identifier500611820
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: