Individual
MS. KATIE JAYNE BENTON KENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2726 NE DIAMOND LAKE BLVD, ROSEBURG, OR 97470-3649
(541) 236-2236
(866) 499-5715
Mailing address
PO BOX 1273, ROSEBURG, OR 97470-0308
(541) 236-2236
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
A5202
OR
1041C0700X
Clinical Social Worker
Primary
L10568
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670891
—
OR
Enumeration date
03/05/2012
Last updated
02/01/2024
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