Provider Demographics
NPI:1609242718
Name:BUCKO, KATHERINE (MA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BUCKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FICKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9670 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3307
Practice Address - Country:US
Practice Address - Phone:503-626-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor