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Individual

MR. KERMIT WILLIAM DUHON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
2700 NW STEWART PKWY, ROSEBURG, OR 97471-1281
(541) 464-4456
(541) 440-3554
Mailing address
272 NW MEDICAL LOOP STE E, ROSEBURG, OR 97471-5545
(541) 464-4456

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L4959
OR
1041C0700X
Clinical Social Worker
2209-C
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2209-C
LCSW LICENSE NUMBER
AR
05
500646713
OR
01
R160755
MEDICARE PTAN
OR
Enumeration date
04/15/2008
Last updated
01/08/2015
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