Provider Demographics
NPI:1245485507
Name:SCHLIEVERT, KIMBERLY H (PHD IN PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:H
Last Name:SCHLIEVERT
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 82ND DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1803
Mailing Address - Country:US
Mailing Address - Phone:503-659-5515
Mailing Address - Fax:503-659-1994
Practice Address - Street 1:880 82ND DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1803
Practice Address - Country:US
Practice Address - Phone:503-659-5515
Practice Address - Fax:503-659-1994
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1968103TC0700X
CA12529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR164936Medicaid