Provider Demographics
NPI:1366216053
Name:ATWOOD, KYMBERLIE ANN (MSW, MA PC-A)
Entity type:Individual
Prefix:
First Name:KYMBERLIE
Middle Name:ANN
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:MSW, MA PC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 44TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5412
Mailing Address - Country:US
Mailing Address - Phone:360-319-5908
Mailing Address - Fax:
Practice Address - Street 1:355 MILLER ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4247
Practice Address - Country:US
Practice Address - Phone:360-319-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health