Healthcare Provider Details

I. General information

NPI: 1780099366
Provider Name (Legal Business Name): KATHERINE J SNOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 SW BARNES RD SUITE 299
PORTLAND OR
97225-6772
US

IV. Provider business mailing address

7650 SW BEVELAND RD SUITE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-3660
  • Fax: 503-297-7637
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6188
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: