Individual
TAWNIE GOETZ-KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2700 STEWART PARKWAY, ANNEX B, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Mailing address
272 MEDICAL LOOP, SUITE E, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500663505
—
OR
Enumeration date
12/06/2012
Last updated
05/07/2015
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