Healthcare Provider Details

I. General information

NPI: 1083812796
Provider Name (Legal Business Name): PATTI MARIE O'HANLON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11456 NE KNOTT ST
PORTLAND OR
97220-1706
US

IV. Provider business mailing address

14465 SE HILLGROVE CT
MILWAUKIE OR
97267-1528
US

V. Phone/Fax

Practice location:
  • Phone: 503-736-6527
  • Fax: 503-256-9601
Mailing address:
  • Phone: 503-736-6527
  • Fax: 503-256-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: