Provider Demographics
NPI:1780337071
Name:WOMACK, KATHERINE ADELLE (CRM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ADELLE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7689
Mailing Address - Country:US
Mailing Address - Phone:541-200-1584
Mailing Address - Fax:541-608-2888
Practice Address - Street 1:1025 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7689
Practice Address - Country:US
Practice Address - Phone:541-200-1584
Practice Address - Fax:541-608-2888
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist