MEDICARE: MS. KATHARINE MCWANE DOEL 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	L2513	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00378200	OTHER	OR	REGENCE BCBS

General Provider Information

NPI Number	:	1861527145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHARINE MCWANE DOEL LCSW

Provider Business Mailing Address
First Line	:	2188 SW PARK PL STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1100
Country	:	US
Telephone Number	:	503-544-6267
Fax Number	:

Provider Business Practice Location Address
First Line	:	2188 SW PARK PL STE 201
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1100
Country	:	US
Telephone Number	:	503-544-6267
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/02/2019

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