Provider Demographics
NPI:1598257859
Name:MAWSON, KATHLEEN CHANDRA (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CHANDRA
Last Name:MAWSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:MAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD, CCC-A, FAAA
Mailing Address - Street 1:333 SE 7TH AVE STE 4150
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4157
Mailing Address - Country:US
Mailing Address - Phone:503-352-2661
Mailing Address - Fax:503-924-6704
Practice Address - Street 1:333 SE 7TH AVE STE 4150
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4157
Practice Address - Country:US
Practice Address - Phone:503-352-2661
Practice Address - Fax:503-924-6704
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR030912237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500751002Medicaid