Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003009879 |
---|---|
Provider Name | George William Kemper JR. |
First Address | Corvallis, OR 97330-9695 |
Second Address | Corvallis, OR 97330-9695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 24/08/2007 |