Provider Demographics
NPI:1730335894
Name:WARNER, KATHERINE (LICENSED PSYCHOLOGIS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 DELTA WATERS RD
Mailing Address - Street 2:#102-266
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9181
Mailing Address - Country:US
Mailing Address - Phone:541-772-3524
Mailing Address - Fax:541-499-0085
Practice Address - Street 1:1016 COURT ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5728
Practice Address - Country:US
Practice Address - Phone:541-772-3524
Practice Address - Fax:541-499-0085
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
OR2183103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health