Provider Demographics
NPI:1528359262
Name:QUERIN, KATHY (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:QUERIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 SW BEVELAND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8665
Mailing Address - Country:US
Mailing Address - Phone:503-620-4000
Mailing Address - Fax:503-639-8987
Practice Address - Street 1:7175 SW BEVELAND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8665
Practice Address - Country:US
Practice Address - Phone:503-620-4000
Practice Address - Fax:503-639-8987
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2016101Y00000X
OR09-06-41101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)