Provider Demographics
NPI:1225184682
Name:KAVANAUGH, KATHARINE DUNN (MS, RN)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:DUNN
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:MS, RN
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Mailing Address - Street 1:2156 N WILLAMETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4407
Mailing Address - Country:US
Mailing Address - Phone:503-422-0700
Mailing Address - Fax:503-224-6047
Practice Address - Street 1:521 SW 11TH AVE
Practice Address - Street 2:CARLYLE BUILDING SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2634
Practice Address - Country:US
Practice Address - Phone:503-827-3035
Practice Address - Fax:503-224-6047
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR201242476RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health