Individual
KATHLEEN HOLCOM DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
340 NW 5TH ST, BOX 1710, REDMOND, OR 97756-1869
(541) 475-6575
(541) 504-1195
Mailing address
125 SW C ST, MADRAS, OR 97741-1458
(541) 475-6575
(541) 504-1195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/11/2016
Last updated
01/11/2016
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