Healthcare Provider Details

I. General information

NPI: 1154691533
Provider Name (Legal Business Name): KATHERINE WARNER LICENSED PSYCHOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 COURT ST
MEDFORD OR
97501-5728
US

IV. Provider business mailing address

1750 DELTA WATERS RD # 102-266
MEDFORD OR
97504-9181
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-3524
  • Fax: 541-499-0085
Mailing address:
  • Phone: 541-772-3524
  • Fax: 541-499-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2183
License Number StateOR

VIII. Authorized Official

Name: DR. KATHERINE WARNER
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 541-621-5104