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General NPI Number Information
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NPI Number | 1043996739
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Entity Type | Individual
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Provider Name | KAITLYN RUTH EATON
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 24499 SW GRAHAMS FERRY RD
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City | WILSONVILLE
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State | OR
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Zip | 97070-7523
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Country | US
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Telephone | 503-570-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 8510 N IVANHOE ST APT 203
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City | PORTLAND
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State | OR
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Zip | 97203-4989
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Country | US
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Telephone | 503-320-9274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L11103
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License Number State | OR
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