Provider Demographics
NPI:1346794591
Name:DREW, KIMBERLY (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DREW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 NW BROADWAY ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2776
Mailing Address - Country:US
Mailing Address - Phone:541-668-7558
Mailing Address - Fax:541-526-3008
Practice Address - Street 1:754 NW BROADWAY ST
Practice Address - Street 2:SUITE #207
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2776
Practice Address - Country:US
Practice Address - Phone:541-668-7558
Practice Address - Fax:541-526-3008
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4207101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral