Healthcare Provider Details

I. General information

NPI: 1801765565
Provider Name (Legal Business Name): KATHRYN HOFFMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 SE HOLGATE BLVD
PORTLAND OR
97202-3415
US

IV. Provider business mailing address

3119 SE HOLGATE BLVD
PORTLAND OR
97202-3415
US

V. Phone/Fax

Practice location:
  • Phone: 503-916-6209
  • Fax:
Mailing address:
  • Phone: 503-916-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number503494
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: