MEDICARE: MS. KATHLEEN JO HUSSEY LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	02380	OR

General Provider Information

NPI Number	:	1174618912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN JO HUSSEY LCSW

Provider Business Mailing Address
First Line	:	2223 NE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1911
Country	:	US
Telephone Number	:	503-317-7814
Fax Number	:	971-255-0466

Provider Business Practice Location Address
First Line	:	2223 NE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1911
Country	:	US
Telephone Number	:	503-317-7814
Fax Number	:	971-255-0466

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/17/2009

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