Provider Demographics
NPI:1255620274
Name:KERPER, EMILEE (QMHP)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:KERPER
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 E ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1227
Mailing Address - Country:US
Mailing Address - Phone:503-851-7524
Mailing Address - Fax:
Practice Address - Street 1:565 UNION ST NE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2418
Practice Address - Country:US
Practice Address - Phone:503-851-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103K00000X
ORA149581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA14958OtherSTATE OF OREGON BOARD OF LICENSED SOCIAL WORKERS LICENSE NUMBER