Healthcare Provider Details

I. General information

NPI: 1770320806
Provider Name (Legal Business Name): WITH CONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 SE 22ND AVE
PORTLAND OR
97214-4848
US

IV. Provider business mailing address

1704 SE 22ND AVE
PORTLAND OR
97214-4848
US

V. Phone/Fax

Practice location:
  • Phone: 503-473-2081
  • Fax:
Mailing address:
  • Phone: 503-473-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KATE STATMAN-WEIL
Title or Position: DIRECTOR
Credential: EDD, LCSW
Phone: 503-473-2081