Healthcare Provider Details

I. General information

NPI: 1982065199
Provider Name (Legal Business Name): KATHERYN JO WARD QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WESTGATE BLDG 2
PENDLETON OR
97801-9613
US

IV. Provider business mailing address

PO BOX 987
PENDLETON OR
97801-0987
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax:
Mailing address:
  • Phone: 541-276-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: