Provider Demographics
NPI:1477148211
Name:ROY, KATIE (MSW, CSWA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6161
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0161
Mailing Address - Country:US
Mailing Address - Phone:971-832-9376
Mailing Address - Fax:
Practice Address - Street 1:280 COURT ST NE STE 205
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3438
Practice Address - Country:US
Practice Address - Phone:971-832-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA102871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical