Kalpanatit Javon Broderick, BA

NPI #1912275728 in Jasper, Oregon

Provider Information

NPI Number: 1912275728
Entity Type: Individual
Name: Kalpanatit Javon Broderick, BA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Credential: BA
Enumeration Date: Dec 7, 2011
Last Updated: Dec 7, 2011

Practice Location

Address: 37875 JASPER LOWELL RD
City: Jasper
State: Oregon
ZIP Code: 97438-9751
Phone: (541) 747-1235

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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