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NPI Code Detail

MEDICARE: KATHLEEN J WAFER

MEDICARE: KATHLEEN J WAFER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorOR
2172V00000XCommunity Health Worker
3171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104180090
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN J WAFER
Provider Business Mailing Address
First Line : PO BOX 1121
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-0254
Country : US
Telephone Number : 541-672-2691
Fax Number :
Provider Business Practice Location Address
First Line : 548 SE JACKSON ST
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-4983
Country : US
Telephone Number : 541-440-3532
Fax Number : 541-440-3554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2012
Last Update Date : 09/06/2023

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Directions to “ KATHLEEN J WAFER ” Practice Location

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