Healthcare Provider Details

I. General information

NPI: 1790851582
Provider Name (Legal Business Name): KATHERINE LING-GONG GREENE PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 BEAR CREEK DR
PHOENIX OR
97535-9626
US

IV. Provider business mailing address

5165 DARK HOLLOW RD
MEDFORD OR
97501-9698
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6665
  • Fax: 541-535-6665
Mailing address:
  • Phone: 541-245-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1487
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2780
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: