Individual
KISCA KAY MERRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA-R
Contact information
Practice address
2045 SILVERTON RD NE STE B, SALEM, OR 97301-0100
(503) 588-5351
(503) 361-2666
Mailing address
1118 OAK ST SE, SALEM, OR 97301-4019
(503) 585-4949
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
NO.23-QMHA-R-3693
OR
175T00000X
Peer Specialist
104611
OR
Other
Enumeration date
03/14/2021
Last updated
06/10/2024
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