Individual
KEVIN LEONARD GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
1913 MEADE ST, NORTH BEND, OR 97459-3432
(541) 756-4508
Mailing address
715 SW RAMSEY AVE, GRANTS PASS, OR 97527-5500
(541) 956-4943
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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