Healthcare Provider Details

I. General information

NPI: 1457525008
Provider Name (Legal Business Name): KERMIT WILLIAM DUHON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL DUHON LCSW

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NW STEWART PKWY
ROSEBURG OR
97471-1281
US

IV. Provider business mailing address

272 NW MEDICAL LOOP STE E
ROSEBURG OR
97471-5545
US

V. Phone/Fax

Practice location:
  • Phone: 541-464-4456
  • Fax: 541-440-3554
Mailing address:
  • Phone: 541-464-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2209-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL4959
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: