Provider Demographics
NPI:1750091674
Name:PADFIELD, KEVIN J PATRICK (CRM THW PSS MHFA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J PATRICK
Last Name:PADFIELD
Suffix:
Gender:M
Credentials:CRM THW PSS MHFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3221
Mailing Address - Country:US
Mailing Address - Phone:971-570-3219
Mailing Address - Fax:
Practice Address - Street 1:1506 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3221
Practice Address - Country:US
Practice Address - Phone:971-570-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000106725175T00000X
OR22-CRM-972175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty