Healthcare Provider Details

I. General information

NPI: 1245684638
Provider Name (Legal Business Name): KATHRYN KANANI LEONARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 25694
PORTLAND OR
97298-0694
US

IV. Provider business mailing address

PO BOX 25694
PORTLAND OR
97298-0694
US

V. Phone/Fax

Practice location:
  • Phone: 503-330-2958
  • Fax:
Mailing address:
  • Phone: 503-330-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18623
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: