Healthcare Provider Details

I. General information

NPI: 1114957099
Provider Name (Legal Business Name): KATHERINE KNOWLES MCLACHLAN CPM, LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SE GRANT ST
PORTLAND OR
97214-5411
US

IV. Provider business mailing address

2045 SE GRANT ST
PORTLAND OR
97214-5411
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-3243
  • Fax:
Mailing address:
  • Phone: 503-234-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberDEM-LD-375485
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: