Individual
KIMBERLY ANN MEDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2480 NE TWIN KNOLLS DR, BEND, OR 97701-6833
(541) 848-1801
Mailing address
16187 DAWN RD, LA PINE, OR 97739-8842
(541) 848-1801
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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