Provider Demographics
NPI:1164284907
Name:WOOD, KRISTEN AMBER (QMHA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AMBER
Last Name:WOOD
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OR
Mailing Address - Zip Code:97456-9422
Mailing Address - Country:US
Mailing Address - Phone:541-731-9230
Mailing Address - Fax:
Practice Address - Street 1:605 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OR
Practice Address - Zip Code:97456-9422
Practice Address - Country:US
Practice Address - Phone:541-731-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-QMHA-I-02047171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator