Provider Demographics
NPI:1023174166
Name:BAPTISTE-MCKINNEY, KATHLEEN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:BAPTISTE-MCKINNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:BAPTISTE-MCKINNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1698 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4348
Mailing Address - Country:US
Mailing Address - Phone:503-363-5435
Mailing Address - Fax:503-364-7272
Practice Address - Street 1:1698 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4348
Practice Address - Country:US
Practice Address - Phone:503-363-5435
Practice Address - Fax:503-364-7272
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical