Individual
KYLA M MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
109 NW MANZANITA AVENUE, GRANTS PASS, OR 97526
(541) 479-8847
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
19-CRM-273
OR
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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