Provider Demographics
NPI:1003149998
Name:GIBBS, KATHY (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:GIBBS
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 1:290 MOYER LN NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3822
Mailing Address - Country:US
Mailing Address - Phone:503-485-2185
Mailing Address - Fax:503-363-4214
Practice Address - Street 1:290 MOYER LN NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3822
Practice Address - Country:US
Practice Address - Phone:503-485-2185
Practice Address - Fax:503-363-4214
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker