Healthcare Provider Details

I. General information

NPI: 1831447127
Provider Name (Legal Business Name): KATHI S GERSPACH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SW MACADAM AVE SUITE 580
PORTLAND OR
97239
US

IV. Provider business mailing address

5200 SW MACADAM AVE. SUITE 580
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-6603
  • Fax: 503-231-8153
Mailing address:
  • Phone: 971-404-6603
  • Fax: 503-231-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: