Provider Demographics
NPI:1689806507
Name:BARBARA KOLLMAR LLC
Entity Type:Organization
Organization Name:BARBARA KOLLMAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-989-1534
Mailing Address - Street 1:307 E 2ND ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3076
Mailing Address - Country:US
Mailing Address - Phone:503-989-1534
Mailing Address - Fax:503-538-1842
Practice Address - Street 1:307 E 2ND ST
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3076
Practice Address - Country:US
Practice Address - Phone:503-989-1534
Practice Address - Fax:503-538-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1487699583OtherINDIVIDUAL NPI
OR118495Medicare PIN