Healthcare Provider Details

I. General information

NPI: 1851091847
Provider Name (Legal Business Name): KARA SKATTUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 SW UPPER TERRACE DR STE 3
BEND OR
97702-1560
US

IV. Provider business mailing address

1061 NW QUINCY AVE
BEND OR
97703-1653
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-0978
  • Fax:
Mailing address:
  • Phone: 720-425-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR8185
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: