Healthcare Provider Details

I. General information

NPI: 1811610207
Provider Name (Legal Business Name): HAKU MEASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 SW WASHINGTON ST STE 700
PORTLAND OR
97205-3200
US

IV. Provider business mailing address

905 SE 14TH AVE
PORTLAND OR
97214-2569
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61362352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: