Healthcare Provider Details

I. General information

NPI: 1477474674
Provider Name (Legal Business Name): KATHRYN ANN GOLDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 11TH AVE SW
ALBANY OR
97321-2019
US

IV. Provider business mailing address

2625 SE CRYSTAL LAKE DR
CORVALLIS OR
97333-2010
US

V. Phone/Fax

Practice location:
  • Phone: 541-204-1818
  • Fax:
Mailing address:
  • Phone: 541-760-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: