Provider Demographics
NPI:1518236454
Name:CARROLL, KINDRA ANN (MSW)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:ANN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PACIFIC HWY APT 10
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9501
Mailing Address - Country:US
Mailing Address - Phone:541-517-0257
Mailing Address - Fax:
Practice Address - Street 1:1175 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7499
Practice Address - Country:US
Practice Address - Phone:541-324-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker