Basic Information
| Provider Information | |||||||||
| NPI: | 1528190139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MCCABE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MCCABE | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3550 N INTERSTATE AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033415011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3550 N INTERSTATE AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038132000 | ||||||||
| FaxNumber: | 5036558595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4391 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.