Provider Demographics
NPI:1467998229
Name:KATIE AZAROW, LCSW, CADC I
Entity Type:Organization
Organization Name:KATIE AZAROW, LCSW, CADC I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAROW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC I
Authorized Official - Phone:402-253-4713
Mailing Address - Street 1:1312 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1424
Mailing Address - Country:US
Mailing Address - Phone:402-253-4713
Mailing Address - Fax:
Practice Address - Street 1:1312 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1424
Practice Address - Country:US
Practice Address - Phone:402-253-4713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty