Provider Demographics
NPI:1912181330
Name:JANZEN, KATHY HAREM
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:HAREM
Last Name:JANZEN
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 1:921 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2257
Mailing Address - Country:US
Mailing Address - Phone:541-349-7555
Mailing Address - Fax:541-344-8239
Practice Address - Street 1:921 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2257
Practice Address - Country:US
Practice Address - Phone:541-349-7555
Practice Address - Fax:541-344-8239
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist