Individual
KIMBERLEY WOLK GOLLETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1300 NW HARRISON BLVD, SUITE 100, CORVALLIS, OR 97330-6277
(541) 758-1556
Mailing address
PO BOX 2136, CORVALLIS, OR 97339-2136
(541) 758-1556
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1155
OR
103TC0700X
Clinical Psychologist
1542
WA
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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