Individual
KIMBERLY WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2600 CENTER ST NE, SALEM, OR 97301-2669
(503) 947-2882
Mailing address
1805 SE 30TH AVE, PORTLAND, OR 97214-4934
(503) 320-1654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4367
OR
Other
Enumeration date
02/21/2020
Last updated
02/21/2020
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