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NPI Code Detail

MEDICARE: CATHERINE ELAINE VAN VALKENBURGH CADC

MEDICARE: CATHERINE ELAINE VAN VALKENBURGH CADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor15-10-20OR

General Provider Information

NPI Number : 1447756515
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE ELAINE VAN VALKENBURGH CADC
Provider Business Mailing Address
First Line : PO BOX 16756
Second Line :
City : PORTLAND
State : OR
Zip : 97292-0756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7916 SE FOSTER RD
Second Line :
City : PORTLAND
State : OR
Zip : 97206-4289
Country : US
Telephone Number : 503-465-2749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2018
Last Update Date : 04/05/2018

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