Provider Demographics
NPI:1346267184
Name:UGOLINI, KATIE A (PHD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:UGOLINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:503-617-6810
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
054123028OtherBLUE CROSS
293389OtherVALUE OPTIONS