Individual
JUDY L KEPHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MH-FRA
Contact information
Practice address
410 N 9TH ST, COTTAGE GROVE, OR 97424-1307
(541) 942-2850
(541) 942-1574
Mailing address
410 N 9TH ST, COTTAGE GROVE, OR 97424-1307
(541) 942-2850
(541) 942-1574
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019047
—
OR
Enumeration date
12/29/2006
Last updated
07/09/2007
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