Individual
MR. KEVIN DALE BODIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA, C.A.D.C. I
Contact information
Practice address
3180 CENTER ST NE STE 2100, SALEM, OR 97301-4592
(503) 585-4949
Mailing address
3180 CENTER ST NE STE 2100, SALEM, OR 97301-4592
(503) 585-4949
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
93-6002307
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122994
—
OR
Enumeration date
05/24/2011
Last updated
05/08/2022
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