Provider Demographics
NPI:1598882466
Name:WHITEHEAD, VICKIE KINDER (MSW)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:KINDER
Last Name:WHITEHEAD
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 1:535 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4142
Mailing Address - Country:US
Mailing Address - Phone:503-693-6697
Mailing Address - Fax:503-693-0737
Practice Address - Street 1:535 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4142
Practice Address - Country:US
Practice Address - Phone:503-693-6697
Practice Address - Fax:503-693-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 2005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114763Medicare ID - Type UnspecifiedPROF. CORP. UPIN
OR114739Medicare UPIN