Provider Demographics
NPI:1033732482
Name:KERWIN, CORYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:CORYNA
Middle Name:
Last Name:KERWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-0425
Mailing Address - Country:US
Mailing Address - Phone:503-332-6275
Mailing Address - Fax:
Practice Address - Street 1:912 SW TOMAHAWK PL
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OR
Practice Address - Zip Code:97115-9713
Practice Address - Country:US
Practice Address - Phone:503-332-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR36381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7482401OtherDRIVERS LICENSE