Healthcare Provider Details

I. General information

NPI: 1275437477
Provider Name (Legal Business Name): KATELYN GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SW BEAVERTON HILLSDALE HWY STE 310
BEAVERTON OR
97005-3366
US

IV. Provider business mailing address

17558 SW BEAVER CT
BEAVERTON OR
97003-4355
US

V. Phone/Fax

Practice location:
  • Phone: 503-376-9520
  • Fax:
Mailing address:
  • Phone: 503-688-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: