Provider Demographics
NPI:1710433503
Name:HART, JOIE KATHERINE ROSE
Entity Type:Individual
Prefix:
First Name:JOIE
Middle Name:KATHERINE ROSE
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4592
Mailing Address - Country:US
Mailing Address - Phone:503-362-5918
Mailing Address - Fax:503-361-2650
Practice Address - Street 1:190 N 7TH ST #1151
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-1151
Practice Address - Country:US
Practice Address - Phone:503-569-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9946060171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator