Individual
KATHLEEN MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1655 CAPITOL ST NE, SALEM, OR 97301-7845
(503) 877-2815
Mailing address
423 NW 6TH ST APT 11, REDMOND, OR 97756-1685
(714) 603-5692
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
THW000106352
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000106352
OREGON HEALTH AUTHORITY
OR
Enumeration date
03/24/2022
Last updated
03/24/2022
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