Provider Demographics
NPI:1497893143
Name:CONROW, KIMBERLY A (MA, LPC, CADC-1)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:CONROW
Suffix:
Gender:F
Credentials:MA, LPC, CADC-1
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:WALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADC I
Mailing Address - Street 1:1552 N SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4653
Mailing Address - Country:US
Mailing Address - Phone:503-422-1789
Mailing Address - Fax:
Practice Address - Street 1:818 NW 17TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2327
Practice Address - Country:US
Practice Address - Phone:503-248-0011
Practice Address - Fax:503-233-3883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional