Provider Demographics
NPI:1396393518
Name:TROSEN, KATHRYN AMANDA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:AMANDA
Last Name:TROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32700 SE LEEWOOD LN UNIT 27R
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-9530
Mailing Address - Country:US
Mailing Address - Phone:503-410-1751
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2629
Practice Address - Country:US
Practice Address - Phone:503-224-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10178089174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist