Healthcare Provider Details

I. General information

NPI: 1215698543
Provider Name (Legal Business Name): ANNE J. KERR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S GRAPE ST
MEDFORD OR
97501-3147
US

IV. Provider business mailing address

PO BOX 1787
MEDFORD OR
97501-0261
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-8655
  • Fax: 800-433-1396
Mailing address:
  • Phone: 541-500-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNE KERR
Title or Position: OWNER
Credential: PSYCHOLOGIST
Phone: 619-244-9143