1912160169 NPI number — MS. KATHRYN ELIZABETH DAILEY LCSW

Table of content: MS. KATHRYN ELIZABETH DAILEY LCSW (NPI 1912160169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912160169 NPI number — MS. KATHRYN ELIZABETH DAILEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAILEY
Provider First Name:
KATHRYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912160169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2259
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97496-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-679-6129
Provider Business Mailing Address Fax Number:
541-679-5285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
671 SW MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-679-6129
Provider Business Practice Location Address Fax Number:
541-679-5285
Provider Enumeration Date:
07/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4061 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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