Provider Demographics
NPI:1487031290
Name:HANSON, KATHERINE MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:HANSON
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 1:11615 SE FULLER RD
Mailing Address - Street 2:APT # 102
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-1328
Mailing Address - Country:US
Mailing Address - Phone:971-230-8706
Mailing Address - Fax:
Practice Address - Street 1:11615 SE FULLER RD
Practice Address - Street 2:APT # 102
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-1328
Practice Address - Country:US
Practice Address - Phone:971-230-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker