Provider Demographics
NPI:1417518788
Name:SINNER, KATHRYN ALYSIA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALYSIA
Last Name:SINNER
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 1:4207 SE WOODSTOCK BLVD # 315
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6267
Mailing Address - Country:US
Mailing Address - Phone:714-485-5805
Mailing Address - Fax:844-222-5110
Practice Address - Street 1:7419 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:714-485-5805
Practice Address - Fax:844-222-5110
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123538106H00000X
CA114038106H00000X
ORT1925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist