Provider Demographics
NPI:1194580225
Name:CARROLL, KIERSTEN ANN (AA, BA)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22333 SKYVIEW DR UNIT J333
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8235
Mailing Address - Country:US
Mailing Address - Phone:541-968-3069
Mailing Address - Fax:
Practice Address - Street 1:1010 5TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2444
Practice Address - Country:US
Practice Address - Phone:541-968-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health