Provider Demographics
NPI:1245015577
Name:KASBERGER, DEIRDRE LYNN MIMS (BS SOCIOLOGY)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:LYNN MIMS
Last Name:KASBERGER
Suffix:
Gender:F
Credentials:BS SOCIOLOGY
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:62895 HAMBY RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9575
Mailing Address - Country:US
Mailing Address - Phone:541-389-1409
Mailing Address - Fax:541-389-9348
Practice Address - Street 1:19 SW CENTURY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1048
Practice Address - Country:US
Practice Address - Phone:541-389-1409
Practice Address - Fax:541-389-9348
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management