Provider Demographics
NPI:1437408721
Name:HENNESSY, KATHERINE GRACE HOFF (LPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GRACE HOFF
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:GRACE
Other - Last Name:HOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5005 MEADOWS RD STE 405
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4291
Mailing Address - Country:US
Mailing Address - Phone:503-705-3009
Mailing Address - Fax:
Practice Address - Street 1:8770 SW SCOFFINS ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6226
Practice Address - Country:US
Practice Address - Phone:503-684-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5546101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator