Provider Demographics
NPI:1558643635
Name:STARK-BREDEWEG, KAREN JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JO
Last Name:STARK-BREDEWEG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KARIN
Other - Middle Name:JO
Other - Last Name:STARK-BREDEWEG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:921 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE #222
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2257
Mailing Address - Country:US
Mailing Address - Phone:541-686-6000
Mailing Address - Fax:541-433-8239
Practice Address - Street 1:921 COUNTRY CLUB RD
Practice Address - Street 2:SUITE #222
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2257
Practice Address - Country:US
Practice Address - Phone:541-686-6000
Practice Address - Fax:541-433-8239
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical