Provider Demographics
NPI:1154691533
Name:KATHERINE WARNER LICENSED PSYCHOLOGIST
Entity type:Organization
Organization Name:KATHERINE WARNER LICENSED PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-621-5104
Mailing Address - Street 1:1750 DELTA WATERS RD # 102-266
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9181
Mailing Address - Country:US
Mailing Address - Phone:541-772-3524
Mailing Address - Fax:541-499-0085
Practice Address - Street 1:1016 COURT ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5728
Practice Address - Country:US
Practice Address - Phone:541-772-3524
Practice Address - Fax:541-499-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2183103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty