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General NPI Number Information
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NPI Number | 1174618912
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Entity Type | Individual
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Provider Name | KATHLEEN JO HUSSEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 2223 NE 47TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-1911
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Country | US
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Telephone | 503-317-7814
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Fax | 971-255-0466
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Provider Business Mailing Address
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Address Line | 2223 NE 47TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-1911
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Country | US
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Telephone | 503-317-7814
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Fax | 971-255-0466
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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 | 02380
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License Number State | OR
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