Healthcare Provider Details

I. General information

NPI: 1871625798
Provider Name (Legal Business Name): KATARINA SPERRY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 NW EASTMAN PKWY STE 100
GRESHAM OR
97030-3830
US

IV. Provider business mailing address

15835 SE 329TH AVE
BORING OR
97009-7074
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-0742
  • Fax:
Mailing address:
  • Phone: 503-668-0282
  • 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: