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General NPI Number Information
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NPI Number | 1841708054
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Entity Type | Individual
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Provider Name | KELLY DAWN HATTERSHIDE
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Gender | Female
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 7931 NE HALSEY ST STE 200
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City | PORTLAND
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State | OR
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Zip | 97213-6755
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Country | US
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Telephone | 971-803-0138
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Fax | 971-352-1088
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Provider Business Mailing Address
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Address Line | 34575 NOBLE RD
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City | SAINT HELENS
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State | OR
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Zip | 97051-9332
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Country | US
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Telephone | 503-396-3848
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19-QMHA-1-01054
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 19-12-22
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License Number State | OR
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