| Doctor Name: | KENNETH EDWARD SERKOWNEK |
| NPI Number: | 1033356423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 587 |
| Business Practice Address: | 770 Se Kane St Roseburg, OR - 974703943 |
| Business Phone Number: | 5416730057 |
| Business Fax Number: | 5416732270 |
| Mailing Address: | 770 Se Kane St, ROSEBURG |
| State: | OR |
| Postal Code: | 974703943 |
| Phone Number: | 5416730057 |
| Fax Number: | 5416732270 |
| NPI Enumeration Date: | 01/07/2009 |
| NPI Last Update Date: | 01/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 587 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |