Provider Demographics
NPI:1164131603
Name:KATIE UGOLINI PHD LLC
Entity Type:Organization
Organization Name:KATIE UGOLINI PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:UGOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-617-6810
Mailing Address - Street 1:5620 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6106
Mailing Address - Country:US
Mailing Address - Phone:503-449-9690
Mailing Address - Fax:503-536-6794
Practice Address - Street 1:16110 SW REGATTA LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8942
Practice Address - Country:US
Practice Address - Phone:503-617-6810
Practice Address - Fax:503-536-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1346267184OtherINDIVIDUAL NPI