MEDICARE: KATY BROWNELL CALDWELL B.S., M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	104100000X	Social Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053502492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY BROWNELL CALDWELL B.S., M.A.

Provider Business Mailing Address
First Line	:	3415 SE POWELL BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3371
Country	:	US
Telephone Number	:	503-484-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-6949
Country	:	US
Telephone Number	:	503-353-5735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	09/16/2011

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