Provider Demographics
NPI:1467871277
Name:LEAVITT, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LEAVITT
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 1:9280 SE SUNNYBROOK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9353
Mailing Address - Country:US
Mailing Address - Phone:503-233-5548
Mailing Address - Fax:
Practice Address - Street 1:9280 SE SUNNYBROOK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9353
Practice Address - Country:US
Practice Address - Phone:503-233-5548
Practice Address - Fax:503-230-1009
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65324207Y00000X
ORMD192956207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology