Individual
CONNIE J KERSENBROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2330 NE DIVISION ST STE 9B, BEND, OR 97703-3530
(541) 323-5332
(541) 323-5854
Mailing address
2330 NE DIVISION ST STE 9B, BEND, OR 97703-3530
(541) 323-5332
(541) 323-5854
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3576
KS
1041C0700X
Clinical Social Worker
3576
KS
1041C0700X
Clinical Social Worker
Primary
7405
OR
Other
Enumeration date
09/23/2006
Last updated
01/12/2018
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