MEDICARE: MS. KATHRYN REBECCA PLAYFAIR M.A.

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	101YP2500X	Professional Counselor	R2795	OR

General Provider Information

NPI Number	:	1609242130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN REBECCA PLAYFAIR M.A.

Provider Business Mailing Address
First Line	:	4017 NE FLANDERS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3323
Country	:	US
Telephone Number	:	503-610-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 NE FLANDERS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3323
Country	:	US
Telephone Number	:	503-610-6162
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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