Individual
KATHLEEN J WAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
548 SE JACKSON ST, ROSEBURG, OR 97470-4983
(541) 440-3532
(541) 440-3554
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500663506
—
OR
Enumeration date
06/26/2012
Last updated
09/06/2023
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