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NPI Code Detail

MEDICARE: MS. VICKIE KINDER WHITEHEAD MSW

MEDICARE: MS. VICKIE KINDER WHITEHEAD MSW
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 2005OR

General Provider Information

NPI Number : 1598882466
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VICKIE KINDER WHITEHEAD MSW
Provider Business Mailing Address
First Line : 535 SE WASHINGTON ST
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4142
Country : US
Telephone Number : 503-693-6697
Fax Number : 503-693-0737
Provider Business Practice Location Address
First Line : 535 SE WASHINGTON ST
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4142
Country : US
Telephone Number : 503-693-6697
Fax Number : 503-693-0737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/09/2007

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