Provider Demographics
NPI:1184802936
Name:SILVERTHORNE, VICKI KENNY
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:KENNY
Last Name:SILVERTHORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:SILVERTHORNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1223 CALVIN ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5321
Mailing Address - Country:US
Mailing Address - Phone:541-343-3538
Mailing Address - Fax:
Practice Address - Street 1:921 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 222
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2257
Practice Address - Country:US
Practice Address - Phone:541-686-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR1097172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker